Basic Information
| Provider Information | |||||||||
| NPI: | 1700037744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAURER | ||||||||
| FirstName: | MARY ANN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 MORRIS STREET | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253011326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043883323 | ||||||||
| FaxNumber: | 3043887294 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 KOONTZ AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CLENDENIN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250459581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045487272 | ||||||||
| FaxNumber: | 3045487149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2008 | ||||||||
| LastUpdateDate: | 11/24/2015 | ||||||||
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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 | 207Q00000X | 2504 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.