Provider Demographics
NPI:1518956283
Name:MAFFEI, MARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:MAFFEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7000 ATRIUM WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-291-6818
Mailing Address - Fax:856-291-6819
Practice Address - Street 1:2225 E EVESHAM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1557
Practice Address - Country:US
Practice Address - Phone:856-795-4330
Practice Address - Fax:856-325-3704
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2020-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06621300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7924704Medicaid
NJ027047YBAWMedicare PIN
NJ7924704Medicaid
NJG92749Medicare UPIN