Healthcare Provider Details

I. General information

NPI: 1770543738
Provider Name (Legal Business Name): CORNELIUS CREEDON MAHER III MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ATTN: CREDENTIALS OFFICE CMR 442
APO AE
09042
DE

IV. Provider business mailing address

ATTN: CREDENTIALS OFFICE CMR 442
APO AE
09042
DE

V. Phone/Fax

Practice location:
  • Phone: 49622117
  • Fax: 496221172941
Mailing address:
  • Phone: 49622117
  • Fax: 496221172941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG 63002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: