Provider Demographics
NPI:1760091086
Name:MAHER, PATRICK ANTHONY
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:ANTHONY
Last Name:MAHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:ANTHONY
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MR
Mailing Address - Street 1:8023 HAMPTON PARK BLVD E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2938
Mailing Address - Country:US
Mailing Address - Phone:904-229-6436
Mailing Address - Fax:
Practice Address - Street 1:1451 AVE DR. ASHFORD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:904-229-6436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program