Healthcare Provider Details

I. General information

NPI: 1528248747
Provider Name (Legal Business Name): MAYA K THOSANI MD, FAAD, FACMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7337 E 2ND ST
SCOTTSDALE AZ
85251-5603
US

IV. Provider business mailing address

7337 E 2ND ST
SCOTTSDALE AZ
85251-5603
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-8741
  • Fax: 480-712-9518
Mailing address:
  • Phone: 480-712-8741
  • Fax: 480-712-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number237598
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number49156
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number49156
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: