Provider Demographics
NPI:1487912804
Name:BRIAN J. MARIEN MD LLC
Entity type:Organization
Organization Name:BRIAN J. MARIEN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-714-2720
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:570-714-2720
Mailing Address - Fax:570-714-2721
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:570-714-2720
Practice Address - Fax:570-714-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073237L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG21252Medicare UPIN