Healthcare Provider Details

I. General information

NPI: 1144224999
Provider Name (Legal Business Name): MAIA S MCCUISTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW STE 2300
WASHINGTON DC
20010-2959
US

IV. Provider business mailing address

106 IRVING ST NW STE 218
WASHINGTON DC
20010-2993
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-6257
  • Fax:
Mailing address:
  • Phone: 734-972-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD039436
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101236606
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD72871
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: