Provider Demographics
NPI:1336100676
Name:MAUL, MARY MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:MAUL
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 8
Mailing Address - Street 2:
Mailing Address - City:STATELINE
Mailing Address - State:NV
Mailing Address - Zip Code:89449-0008
Mailing Address - Country:US
Mailing Address - Phone:775-586-5000
Mailing Address - Fax:775-586-5055
Practice Address - Street 1:15 HWY 50
Practice Address - Street 2:HARRAH'S TAHOE HEALTH AND WELLNESS CENTER
Practice Address - City:STATELINE
Practice Address - State:NV
Practice Address - Zip Code:89449-0008
Practice Address - Country:US
Practice Address - Phone:775-586-5000
Practice Address - Fax:775-586-5055
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016265Medicaid
NVC96771Medicare UPIN
NV2016265Medicaid