Provider Demographics
NPI:1700977238
Name:MAHOWALD, MAREN LAWSON (MD)
Entity Type:Individual
Prefix:DR
First Name:MAREN
Middle Name:LAWSON
Last Name:MAHOWALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 OTIS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5636
Mailing Address - Country:US
Mailing Address - Phone:651-647-9620
Mailing Address - Fax:612-725-2267
Practice Address - Street 1:ONE VETERANS DRIVE
Practice Address - Street 2:MINNEAPOLIS VA MEDICAL CENTER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417
Practice Address - Country:US
Practice Address - Phone:612-467-4190
Practice Address - Fax:612-725-2267
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21181207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology