Provider Demographics
NPI:1558368845
Name:AXELROD, MARIA G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:G
Last Name:AXELROD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3745 CHEROKEE ST NW STE 401
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6787
Mailing Address - Country:US
Mailing Address - Phone:770-429-1005
Mailing Address - Fax:770-429-8005
Practice Address - Street 1:3745 CHEROKEE ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6733
Practice Address - Country:US
Practice Address - Phone:770-429-1005
Practice Address - Fax:770-429-8005
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059367208000000X
NY229898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1167817Medicaid