Provider Demographics
NPI:1952933830
Name:PAUL D MAHER MD INC
Entity type:Organization
Organization Name:PAUL D MAHER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATINS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-204-0310
Mailing Address - Street 1:55 E CALIFORNIA BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3944
Mailing Address - Country:US
Mailing Address - Phone:626-793-1227
Mailing Address - Fax:626-993-9200
Practice Address - Street 1:55 E CALIFORNIA BLVD FL 3
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3944
Practice Address - Country:US
Practice Address - Phone:626-793-1227
Practice Address - Fax:626-993-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70371OtherSTATE LICENSE