Provider Demographics
NPI:1275043556
Name:MAHARI, MELANIE (NP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MAHARI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 LIGHT ARMS PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2548
Mailing Address - Country:US
Mailing Address - Phone:240-435-1055
Mailing Address - Fax:
Practice Address - Street 1:3350 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4850
Practice Address - Country:US
Practice Address - Phone:888-808-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR205387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR205387OtherMARYLAND BOARD OF NURSING