Provider Demographics
NPI:1477558559
Name:MAILLIS, MAXWELL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:S
Last Name:MAILLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 BREAKERS LN
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-4845
Mailing Address - Country:US
Mailing Address - Phone:828-665-8289
Mailing Address - Fax:
Practice Address - Street 1:4601 BREAKERS LN
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-4845
Practice Address - Country:US
Practice Address - Phone:828-665-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0007903207RC0000X
VA0101023333207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB93350Medicare UPIN