Provider Demographics
NPI:1518911411
Name:FREEMAN BRNDJAR, MARYANNE (DO)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:FREEMAN BRNDJAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1120
Mailing Address - Country:US
Mailing Address - Phone:610-965-6200
Mailing Address - Fax:610-965-6211
Practice Address - Street 1:4 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1120
Practice Address - Country:US
Practice Address - Phone:610-965-6200
Practice Address - Fax:610-965-6211
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008332L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016012750003Medicaid
PA043696299OtherVALLEY PREFERRED
PA20009508OtherAMERIHEALTH MERCY
PA043696299OtherCHOICE PLUS
PA043696299OtherCIGNA
PA043969299OtherEPHN
PA50027457OtherKEYSTONE HEALTH CENTRAL
PA043969299OtherAMERIHEALTH ADMINISTRATOR
PA1537175OtherHIGHMARK BLUE SHIELD
PA50027457OtherCAPITAL BLUE CROSS
PA3357346OtherAETNA
PA0135273000OtherKEYSTONE EAST
PA043696299OtherUNITED HEALTHCARE
PA0135273000OtherKEYSTONE EAST
PA043696299OtherUNITED HEALTHCARE