Healthcare Provider Details

I. General information

NPI: 1720213838
Provider Name (Legal Business Name): NJERI MAINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE MAINA

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 BROOKWOOD BLVD
BIRMINGHAM AL
35209
US

IV. Provider business mailing address

504 BROOKWOOD BLVD
BIRMINGHAM AL
35209-6802
US

V. Phone/Fax

Practice location:
  • Phone: 205-871-9661
  • Fax: 205-870-1621
Mailing address:
  • Phone: 205-871-9661
  • Fax: 205-870-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number35069
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME113021
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberME113021
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35069
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: