MEDICARE: PROF. BLAIR J MAEROWITZ PA-C

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	363A00000X	Physician Assistant	1521	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	290001521MA01	OTHER	MA	ANTHEM
3	114411681	OTHER	MA	GROUP NPI

General Provider Information

NPI Number	:	1235107970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. BLAIR J MAEROWITZ PA-C

Provider Business Mailing Address
First Line	:	29B COTTAGE ST
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-1206
Country	:	US
Telephone Number	:	508-754-3823
Fax Number	:	508-753-0151

Provider Business Practice Location Address
First Line	:	29 COTTAGE STREET
Second Line	:	B (PIONEER VALLEY DERMATOLOGY)
City	:	AMHERST
State	:	MA
Zip	:	01002-1206
Country	:	US
Telephone Number	:	413-406-3250
Fax Number	:	413-549-7402

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	03/15/2021

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