Provider Demographics
NPI:1457440604
Name:CARDWELL, MAURA W (MD)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:W
Last Name:CARDWELL
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 1:12333 NE 130TH LN
Mailing Address - Street 2:#110
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7467
Mailing Address - Country:US
Mailing Address - Phone:425-285-0060
Mailing Address - Fax:425-285-0070
Practice Address - Street 1:12333 NE 130TH LN
Practice Address - Street 2:#110
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7467
Practice Address - Country:US
Practice Address - Phone:425-285-0060
Practice Address - Fax:425-285-0070
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00026199207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1160498Medicaid
WAMD00026199OtherSTATE LICENSE
WA1160498Medicaid
WAGAB11690Medicare PIN