Provider Demographics
NPI:1972562684
Name:DORAN-BARR, MARY JOAN (MSN, RN, APN)
Entity type:Individual
Prefix:MRS
First Name:MARY JOAN
Middle Name:
Last Name:DORAN-BARR
Suffix:
Gender:F
Credentials:MSN, RN, APN
Other - Prefix:MRS
Other - First Name:MARY JOAN
Other - Middle Name:R
Other - Last Name:DORAN-BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,RN,APN
Mailing Address - Street 1:9 DUTCHTOWN HARLINGEN RD
Mailing Address - Street 2:MONTGOMERY MEDICAL ASSOC, LLC
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-5115
Mailing Address - Country:US
Mailing Address - Phone:908-874-8883
Mailing Address - Fax:908-874-5108
Practice Address - Street 1:9 DUTCHTOWN HARLINGEN RD
Practice Address - Street 2:MONTGOMERY MEDICAL ASSOC, LLC
Practice Address - City:BELLE MEAD
Practice Address - State:NJ
Practice Address - Zip Code:08502-5115
Practice Address - Country:US
Practice Address - Phone:908-874-8883
Practice Address - Fax:908-874-5108
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN04484700363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7558007Medicaid
NJ7558007Medicaid
NJ007252Medicare PIN