Healthcare Provider Details

I. General information

NPI: 1609123207
Provider Name (Legal Business Name): MAXWELL IRVING MAYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 HILLSIDE ST
FALL RIVER MA
02720-5211
US

IV. Provider business mailing address

85 E NEWTON ST SUITE 802, 8/F
BOSTON MA
02118-2841
US

V. Phone/Fax

Practice location:
  • Phone: 508-235-7333
  • Fax:
Mailing address:
  • Phone: 617-638-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number274121
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: