Provider Demographics
NPI:1689191553
Name:MAHER, MARY CATHERINE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MARY CATHERINE
Middle Name:
Last Name:MAHER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PECKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840
Mailing Address - Country:US
Mailing Address - Phone:401-486-2672
Mailing Address - Fax:
Practice Address - Street 1:535 CENTERVILLE RD STE 102
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4376
Practice Address - Country:US
Practice Address - Phone:401-773-7220
Practice Address - Fax:401-773-7221
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00996363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant