Provider Demographics
NPI:1306894415
Name:MARIEN, BRIAN J (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:MARIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5751
Mailing Address - Country:US
Mailing Address - Phone:570-287-2700
Mailing Address - Fax:570-287-1570
Practice Address - Street 1:540 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5751
Practice Address - Country:US
Practice Address - Phone:570-287-2700
Practice Address - Fax:570-287-1570
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD074237L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA814563OtherFIRST PRIORITY HEALTH
PA0018396760001Medicaid
63921OtherGEISINGER HEALTH PLAN
PAMA927912OtherHIGHMARK BLUE SHIELD
PAG21252OtherSTERLING OPTION 1
PA2793623OtherAETNA
PA158007OtherHEALTH AMERICA
PAMA927912OtherHIGHMARK BLUE SHIELD
G21252Medicare UPIN