Provider Demographics
NPI:1851033674
Name:DREW E MARIS MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DREW E MARIS MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-588-7816
Mailing Address - Street 1:155 ANDERSEN DR STE 1108
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3999
Mailing Address - Country:US
Mailing Address - Phone:415-455-0914
Mailing Address - Fax:415-454-4315
Practice Address - Street 1:155 ANDERSEN DR STE 1108
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3999
Practice Address - Country:US
Practice Address - Phone:415-455-0914
Practice Address - Fax:415-454-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty