Provider Demographics
NPI:1972539930
Name:MAHER, MARY GREY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY GREY
Middle Name:
Last Name:MAHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:330 ORCHARD ST
Mailing Address - Street 2:SUITE 164
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4417
Mailing Address - Country:US
Mailing Address - Phone:203-789-2222
Mailing Address - Fax:203-624-3697
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:SUITE 164
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-789-2222
Practice Address - Fax:203-624-3697
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT042767208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT340000367Medicare ID - Type UnspecifiedMEDICARE NUMBER
CTI22352Medicare UPIN