Provider Demographics
NPI:1386044204
Name:MATTU, MAGGIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:
Last Name:MATTU
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 S WOLFE ST APT 113
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3652
Mailing Address - Country:US
Mailing Address - Phone:570-691-6346
Mailing Address - Fax:
Practice Address - Street 1:6635 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1845
Practice Address - Country:US
Practice Address - Phone:410-254-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist