MEDICARE: DR. GIRARD M MARYNIAK MD

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	207V00000X	Obstetrics & Gynecology Physician	MD023735E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01158902	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1326002981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIRARD M MARYNIAK MD

Provider Business Mailing Address
First Line	:	1234 PENN AVE
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-2130
Country	:	US
Telephone Number	:	610-374-4282
Fax Number	:	610-374-2403

Provider Business Practice Location Address
First Line	:	1234 PENN AVE
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-2130
Country	:	US
Telephone Number	:	610-374-4282
Fax Number	:	610-374-2403

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	07/08/2007

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