Healthcare Provider Details

I. General information

NPI: 1134746910
Provider Name (Legal Business Name): DAVID MAINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: N/A N/A

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 RACE ROAD STE 403
ROSEDALE MD
21237-2123
US

IV. Provider business mailing address

1232 RACE ROAD STE 403
ROSEDALE MD
21237-1558
US

V. Phone/Fax

Practice location:
  • Phone: 443-868-7101
  • Fax: 443-732-0054
Mailing address:
  • Phone: 443-868-7101
  • Fax: 443-732-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR180133
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: