Healthcare Provider Details

I. General information

NPI: 1073889499
Provider Name (Legal Business Name): MARY G. TIERNEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 WILLOW STREET PIKE SUITE J
WILLOW STREET PA
17584-1758
US

IV. Provider business mailing address

1227 WILLOW STREET PIKE
LANCASTER PA
17602-4631
US

V. Phone/Fax

Practice location:
  • Phone: 717-723-9104
  • Fax: 717-349-9388
Mailing address:
  • Phone: 717-723-9104
  • Fax: 717-349-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberPAK000223
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101258266
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD94419
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD456991
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD456991
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: