Mary G. Tierney, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD456991 Issued in PA

Practice address

2819 Willow Street Pike
Suite J
Willow Street, PA 17584-1758

Phone

(717) 723-9104

Fax

(717) 349-9388

NPI assigned

Mar 29, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Aug 26, 2022 through Aug 26, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: mtierney@direct-address.net

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1073889499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1227 WILLOW STREET PIKE",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176024631",
            "telephone_number": "717-723-9104",
            "fax_number": "717-349-9388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2819 WILLOW STREET PIKE",
            "address_2": "SUITE J",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175841758",
            "telephone_number": "717-723-9104",
            "fax_number": "717-349-9388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIERNEY",
        "first_name": "MARY",
        "middle_name": "G.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-29",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "PA",
            "license": "PAK000223",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101258266",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D94419",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "PA",
            "license": "MD456991",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD456991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY MEDICINE",
            "identifier": "88-0786906",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Willow Street, PA
• Providers in Willow Street, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.