Provider Demographics
NPI:1891982526
Name:MARIA MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:MARIA MEDICAL CENTER, PLLC
Other - Org Name:JOSETTE MARIA, MD PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-892-8892
Mailing Address - Street 1:800 SUSAN TART RD
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5506
Mailing Address - Country:US
Mailing Address - Phone:910-892-8892
Mailing Address - Fax:910-892-1063
Practice Address - Street 1:800 SUSAN TART RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334
Practice Address - Country:US
Practice Address - Phone:910-892-8892
Practice Address - Fax:910-892-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 207RG0300X
NC200100412207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950092Medicaid
NC1281EOtherBCBS NC
NC891281EMedicaid
NC2288606Medicare Oscar/Certification
NC2288606Medicare PIN
NCH04645Medicare UPIN