Provider Demographics
NPI:1720362577
Name:MAIORANO, MARY (NP-C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:MAIORANO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 MUSIC VALE RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:CT
Mailing Address - Zip Code:06420-3824
Mailing Address - Country:US
Mailing Address - Phone:860-984-9646
Mailing Address - Fax:
Practice Address - Street 1:1707 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-1105
Practice Address - Country:US
Practice Address - Phone:860-742-9050
Practice Address - Fax:860-742-9097
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1243363LF0000X
CT005206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily