Provider Demographics
NPI:1881650323
Name:MAHER, JAMES O III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:O
Last Name:MAHER
Suffix:III
Gender:M
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:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02901-1119
Mailing Address - Country:US
Mailing Address - Phone:401-849-6868
Mailing Address - Fax:
Practice Address - Street 1:345 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5236
Practice Address - Country:US
Practice Address - Phone:401-849-6868
Practice Address - Fax:401-847-3840
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI07310207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJM12717Medicaid
RI007006577Medicare ID - Type Unspecified
RIE41697Medicare UPIN