Provider Demographics
NPI:1558457127
Name:MAYORGA, MARIA ALICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ALICIA
Last Name:MAYORGA
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2790
Mailing Address - Fax:
Practice Address - Street 1:40 V TWIN DR STE 205
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325
Practice Address - Country:US
Practice Address - Phone:717-339-2790
Practice Address - Fax:717-339-2771
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023726207RP1001X
VA0101277144208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
59795OtherMMA
MDF21469Medicare UPIN