Provider Demographics
NPI:1982130746
Name:MAHER, EAMONN (MD)
Entity Type:Individual
Prefix:
First Name:EAMONN
Middle Name:
Last Name:MAHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PARK AVE UNIT 500
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-2253
Mailing Address - Country:US
Mailing Address - Phone:304-993-9960
Mailing Address - Fax:304-691-1695
Practice Address - Street 1:516 DELAWARE STREET S.E., MAIL CODE 98
Practice Address - Street 2:PHILLIPS-WANGENSTEEN BLDG, SUITE 1-400
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-3662
Practice Address - Country:US
Practice Address - Phone:612-625-8625
Practice Address - Fax:612-624-6678
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN71689207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program