Provider Demographics
NPI:1649216607
Name:MAHER, KERRY A (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:MAHER
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 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-858-7606
Mailing Address - Fax:904-858-7610
Practice Address - Street 1:3901 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4377
Practice Address - Country:US
Practice Address - Phone:904-858-7606
Practice Address - Fax:904-858-7610
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89310208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270758600Medicaid
FLP00262445OtherRR MEDICARE
G13827Medicare UPIN
49099ZMedicare ID - Type Unspecified