Provider Demographics
NPI:1174284087
Name:MAXWELL, ERIC P JR
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:P
Last Name:MAXWELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17833 WHITNEY RD APT 318
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-2451
Mailing Address - Country:US
Mailing Address - Phone:216-246-7519
Mailing Address - Fax:
Practice Address - Street 1:17833 WHITNEY RD APT 318
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-2451
Practice Address - Country:US
Practice Address - Phone:216-246-7519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker