1265561211 NPI number — DR. JOHN FRANCIS MAHER III M.D.

Table of content: DR. JOHN FRANCIS MAHER III M.D. (NPI 1265561211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265561211 NPI number — DR. JOHN FRANCIS MAHER III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHER
Provider First Name:
JOHN
Provider Middle Name:
FRANCIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEAGHER
Provider Other First Name:
JOHN
Provider Other Middle Name:
FRANCIS
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265561211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22924 CRENSHAW BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90505-3023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-328-0091
Provider Business Mailing Address Fax Number:
424-328-0094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22924 CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-3023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-328-0091
Provider Business Practice Location Address Fax Number:
424-328-0094
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G54565 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 330449875 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 330449875 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: G54565 . This is a "PIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000198598 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G545651 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180004317 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 330449875 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G545650 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004080884 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 330449875 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 330449875 . This is a "BLUE CROSS OF CALIF" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 330449875 . This is a "TRICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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