Healthcare Provider Details

I. General information

NPI: 1942298930
Provider Name (Legal Business Name): MARY KURIEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 N EASTON RD
GLENSIDE PA
19038-4301
US

IV. Provider business mailing address

614 N EASTON RD
GLENSIDE PA
19038-4301
US

V. Phone/Fax

Practice location:
  • Phone: 215-884-9770
  • Fax: 215-884-6301
Mailing address:
  • Phone: 215-884-9770
  • Fax: 215-884-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD417894
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: