Healthcare Provider Details

I. General information

NPI: 1720362577
Provider Name (Legal Business Name): MARY MAIORANO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 BOSTON TPKE
COVENTRY CT
06238-1105
US

IV. Provider business mailing address

156 MUSIC VALE RD
SALEM CT
06420-3824
US

V. Phone/Fax

Practice location:
  • Phone: 860-742-9050
  • Fax: 860-742-9097
Mailing address:
  • Phone: 860-984-9646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1243
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005206
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: