Basic Information
| Provider Information | |||||||||
| NPI: | 1588778450 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRS MAURIELLO AND ORFAN PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1125 DIAMOND DR STE B | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217405857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017901482 | ||||||||
| FaxNumber: | 3017901377 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 DIAMOND DR | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217405857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017901482 | ||||||||
| FaxNumber: | 3017901377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 05/01/2020 | ||||||||
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| AuthorizedOfficialLastName: | BEARD | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 3017901482 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 761400400 | 05 | MD | MEDICAID |