Provider Demographics
NPI:1447366570
Name:WARD, MARY-JANE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY-JANE
Middle Name:
Last Name:WARD
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:PO BOX 1395
Mailing Address - Street 2:642 BROOKHILL SQ SOUTH
Mailing Address - City:CONYNGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18219
Mailing Address - Country:US
Mailing Address - Phone:570-788-1222
Mailing Address - Fax:
Practice Address - Street 1:642 BROOKHILL SQ SOUTH
Practice Address - Street 2:
Practice Address - City:CONYNGHAM
Practice Address - State:PA
Practice Address - Zip Code:18219
Practice Address - Country:US
Practice Address - Phone:570-788-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016475E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA156151Medicare ID - Type Unspecified