Basic Information
| Provider Information | |||||||||
| NPI: | 1548349392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11279 PERRY HWY | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150909381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249331100 | ||||||||
| FaxNumber: | 7249331160 | ||||||||
| Practice Location | |||||||||
| Address1: | 4411 STILLEY RD | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152271368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128827747 | ||||||||
| FaxNumber: | 4128822667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 12/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C20006430 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208D00000X | C20006430 | DE | N | Allopathic & Osteopathic Physicians | General Practice | 208000000X | OS010375L | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 71820 | 05 | NJ | MEDICAID | 101681653 | 05 | PA | MEDICAID | 4105796 | 05 | MD | MEDICAID |