Provider Demographics
NPI:1306878178
Name:TINSLEY, BRIA MARIE (MD)
Entity type:Individual
Prefix:
First Name:BRIA
Middle Name:MARIE
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 THIRD AVE.
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434
Mailing Address - Country:US
Mailing Address - Phone:570-383-7922
Mailing Address - Fax:570-383-5450
Practice Address - Street 1:407 THIRD AVE
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:PA
Practice Address - Zip Code:18434-1415
Practice Address - Country:US
Practice Address - Phone:570-383-7922
Practice Address - Fax:570-383-5450
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0344267Medicaid
PA0344267Medicaid
PA103159Medicare PIN