MEDICARE: MARY ANN LEARY DO

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	207Q00000X	Family Medicine Physician	OS008302L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104810860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN LEARY DO

Provider Business Mailing Address
First Line	:	1 W ELM ST
Second Line	:	SUITE 100
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2007
Country	:	US
Telephone Number	:	610-567-6967
Fax Number	:	610-567-6955

Provider Business Practice Location Address
First Line	:	3301 RIDGE PIKE
Second Line	:
City	:	EAGLEVILLE
State	:	PA
Zip	:	19403-1411
Country	:	US
Telephone Number	:	610-539-9100
Fax Number	:	610-539-6570

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	03/25/2008

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Directions to “ MARY ANN LEARY DO” Practice Location

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