Healthcare Provider Details

I. General information

NPI: 1144299017
Provider Name (Legal Business Name): EILEEN M MAHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4775 KNIGHTSBRIDGE BLVD SUITE 207
COLUMBUS OH
43214-4313
US

IV. Provider business mailing address

4775 KNIGHTSBRIDGE BLVD SUITE 207
COLUMBUS OH
43214-4313
US

V. Phone/Fax

Practice location:
  • Phone: 614-442-5557
  • Fax: 614-442-1070
Mailing address:
  • Phone: 614-442-5557
  • Fax: 614-442-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-050254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: