MEDICARE: DR. AMY LOUISE MAHER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LA0401X	Addiction Medicine (Anesthesiology) Physician	61303508	WA
2	207LA0401X	Addiction Medicine (Anesthesiology) Physician	4301507227	MI
3	207LA0401X	Addiction Medicine (Anesthesiology) Physician	4393	FL
4	207LA0401X	Addiction Medicine (Anesthesiology) Physician	A86866	CA
5	207LA0401X	Addiction Medicine (Anesthesiology) Physician	67051	TN
6	207LA0401X	Addiction Medicine (Anesthesiology) Physician	0071050	CO
7	207LA0401X	Addiction Medicine (Anesthesiology) Physician	MC2148	ID
8	207LA0401X	Addiction Medicine (Anesthesiology) Physician	MD166757	OR

General Provider Information

NPI Number	:	1205945995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY LOUISE MAHER MD

Provider Business Mailing Address
First Line	:	4810 POINT FOSDICK DR STE 92
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1711
Country	:	US
Telephone Number	:	253-356-7477
Fax Number	:	888-782-0163

Provider Business Practice Location Address
First Line	:	4810 POINT FOSDICK DR
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1711
Country	:	US
Telephone Number	:	541-816-7336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	06/05/2023

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