Provider Demographics
NPI:1780301655
Name:AMOS, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:AMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 MAYFIELD ROAD #1154
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:216-326-3442
Mailing Address - Fax:440-551-7905
Practice Address - Street 1:6014 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:216-326-3442
Practice Address - Fax:440-551-7905
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOS.136865335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier