MEDICARE: MARY ANNE BARNICLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	MD038816E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1769333	OTHER	PW	HIGHMARK BC BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	078917	OTHER	PA	HIGHMARK BCBS

General Provider Information

NPI Number	:	1689636144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANNE BARNICLE M.D.

Provider Business Mailing Address
First Line	:	1265 WAYNE AVE.
Second Line	:	SUITE 208
City	:	INDIANA
State	:	PA
Zip	:	15701-2776
Country	:	US
Telephone Number	:	724-463-8850
Fax Number	:	724-463-7072

Provider Business Practice Location Address
First Line	:	1265 WAYNE AVE
Second Line	:	SUITE 208
City	:	INDIANA
State	:	PA
Zip	:	15701-2776
Country	:	US
Telephone Number	:	724-463-8850
Fax Number	:	724-463-7072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	12/27/2012

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