MEDICARE: DR. MARIE BRISLIN 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	208000000X	Pediatrics Physician	OS-006887-L	PA
2	208000000X	Pediatrics Physician	C2-0007391	DE

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	:	1518989888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE BRISLIN MD

Provider Business Mailing Address
First Line	:	2600 W 9TH ST
Second Line	:	2 NORTH
City	:	CHESTER
State	:	PA
Zip	:	19013-2040
Country	:	US
Telephone Number	:	610-485-3800
Fax Number	:	610-485-4221

Provider Business Practice Location Address
First Line	:	744 E LINCOLN HWY
Second Line	:	110
City	:	COATESVILLE
State	:	PA
Zip	:	19320-3590
Country	:	US
Telephone Number	:	610-380-4660
Fax Number	:	610-380-4664

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	06/16/2011

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