Provider Demographics
NPI:1114967239
Name:PAVEZ, MARIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:PAVEZ
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 719
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42502-0719
Mailing Address - Country:US
Mailing Address - Phone:606-451-3958
Mailing Address - Fax:606-676-0110
Practice Address - Street 1:154 BOGLE OFFICE PARK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2810
Practice Address - Country:US
Practice Address - Phone:606-451-3958
Practice Address - Fax:606-676-0110
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32321174400000X, 2084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64323215Medicaid
KY1280116Medicare ID - Type Unspecified
KY64323215Medicaid