| Doctor Name: | MARYLYN ANN MUDRICK |
| NPI Number: | 1639132145 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | MD029229E |
| Business Practice Address: | 3303a Edgmout Ave Brookhaven, PA - 190152801 |
| Business Phone Number: | 6108720565 |
| Business Fax Number: | 6108724478 |
| Mailing Address: | 3303a Edgmout Ave, BROOKHAVEN |
| State: | PA |
| Postal Code: | 190152801 |
| Phone Number: | 6108720565 |
| Fax Number: | 6108724478 |
| NPI Enumeration Date: | 04/07/2006 |
| NPI Last Update Date: | 08/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD029229E |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |