Marylyn Ann Mudrick, MD029229E

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD029229E Issued in PA

Practice address

3303A Edgmout Ave
Brookhaven, PA 19015-2801

Phone

(610) 872-0565

Fax

(610) 872-4478

NPI assigned

Apr 7, 2006

Last updated

Dec 31, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in PA

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.

Enrollment records 1

Specialty

Family Practice

Education

Hahnemann University College of Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Main Line Health Home Care & Hospice - Home Health Home health agency, Radnor, PA, CCN 397012
• Riddle Memorial Hospital Hospital, Media, PA, CCN 390222

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chester Family Practice

  • Family Medicine Physician
  • Chester, PA
  • NPI 1356454706
  NPD (past) Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Riddle Memorial Hospital

  • General Acute Care Hospital
  • Media, PA
  • NPI 1407856099
  Care Compare affiliation

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735603200000",
    "number": "1639132145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303A EDGMOUT AVE",
            "city": "BROOKHAVEN",
            "state": "PA",
            "postal_code": "190152801",
            "telephone_number": "610-872-0565",
            "fax_number": "610-872-4478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303A EDGMOUT AVE",
            "city": "BROOKHAVEN",
            "state": "PA",
            "postal_code": "190152801",
            "telephone_number": "610-872-0565",
            "fax_number": "610-872-4478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDRICK",
        "first_name": "MARYLYN",
        "middle_name": "ANN",
        "credential": "MD029229E",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-07",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PA",
            "license": "MD029229E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE BA ST",
            "identifier": "0554265001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01500441",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5023294",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Milligan
• Anvarali Mohammadh, DMD
• Coey Moore
• Danielle Renee Morgan, LPC
• Thomas E Morrison Jr., MS
• Helena M. Mulbah
• Nelson's Surgical, Inc.
• Xiem Nguyen-Yip
• He Ra Nguyen, PHARMD
• Ty Nguyen

• General Practice Physician in Brookhaven, PA
• Providers in Brookhaven, PA by specialty
• General Practice Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.