Provider Demographics
NPI:1689857310
Name:MAHER, PETER DONALD IV (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DONALD
Last Name:MAHER
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:900 STEVENS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3536
Mailing Address - Country:US
Mailing Address - Phone:509-942-3180
Mailing Address - Fax:509-943-9722
Practice Address - Street 1:1270 LEE BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4231
Practice Address - Country:US
Practice Address - Phone:509-942-3180
Practice Address - Fax:509-943-9722
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00035465207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1111962Medicaid
WA1111962Medicaid
G8856212Medicare PIN