Provider Demographics
NPI:1003862582
Name:MAURICIO, EARL JOHN D (MD)
Entity type:Individual
Prefix:DR
First Name:EARL JOHN
Middle Name:D
Last Name:MAURICIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1221 MERCANTILE LN
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5374
Mailing Address - Country:US
Mailing Address - Phone:301-386-6800
Mailing Address - Fax:301-386-6801
Practice Address - Street 1:1221 MERCANTILE LN
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-386-6800
Practice Address - Fax:301-386-6801
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DCMD0434602084P0800X
VA01012585242084P0800X
MA2241052084P0800X
MDD00798682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry