Provider Demographics
NPI:1235125477
Name:MAHER, DONALD JEROME
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JEROME
Last Name:MAHER
Suffix:
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 1:181 HARTMAN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RONKS
Mailing Address - State:PA
Mailing Address - Zip Code:17572-9700
Mailing Address - Country:US
Mailing Address - Phone:717-687-7541
Mailing Address - Fax:717-687-7541
Practice Address - Street 1:181 HARTMAN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:RONKS
Practice Address - State:PA
Practice Address - Zip Code:17572-9700
Practice Address - Country:US
Practice Address - Phone:717-687-7541
Practice Address - Fax:717-687-7541
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001659L111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00634567Medicaid
PAT28776Medicare UPIN
PAMA111012Medicare ID - Type Unspecified