Provider Demographics
NPI:1710923057
Name:REISER, MAYA (MD)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:REISER
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 1:4110 ASPEN HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2853
Mailing Address - Country:US
Mailing Address - Phone:301-438-5150
Mailing Address - Fax:
Practice Address - Street 1:11120 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2633
Practice Address - Country:US
Practice Address - Phone:301-681-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00381012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC017176300Medicaid
VA010075211Medicaid
VA007235445Medicaid
VA010072221Medicaid
VA010075190Medicaid
VA010075203Medicaid
VA010075220Medicaid
VA007234996Medicaid
VA007235437Medicaid
VA007235461Medicaid
MD557641500Medicaid
VA007235461Medicaid
980MJ662Medicare ID - Type UnspecifiedFREDERICK
VA010042461Medicare ID - Type UnspecifiedOLNEY
VA010072221Medicaid
MD557641500Medicaid
VA007235437Medicaid