Individual
MARYLYN ANN MUDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD029229E
Contact information
Practice address
3303A EDGMOUT AVE, BROOKHAVEN, PA 19015-2801
(610) 872-0565
(610) 872-4478
Mailing address
3303A EDGMOUT AVE, BROOKHAVEN, PA 19015-2801
(610) 872-0565
(610) 872-4478
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MD029229E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01500441
—
PA
01
—
0554265001
KEYSTONE BA ST
—
01
—
5023294
AETNA
—
Enumeration date
04/07/2006
Last updated
12/31/2024
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