Provider Demographics
NPI:1568860377
Name:MAYNARD, MEGUMI TAKAYAMA (MD)
Entity Type:Individual
Prefix:
First Name:MEGUMI
Middle Name:TAKAYAMA
Last Name:MAYNARD
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 1:600 SUPERIOR AVENUE, EAST
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114
Mailing Address - Country:US
Mailing Address - Phone:216-443-0430
Mailing Address - Fax:216-443-0435
Practice Address - Street 1:900 E. OAK HILL AVENUE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917
Practice Address - Country:US
Practice Address - Phone:865-545-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine