Healthcare Provider Details

I. General information

NPI: 1467621961
Provider Name (Legal Business Name): NAIR M MARANHAO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 4TH ST
LEBANON PA
17042-6111
US

IV. Provider business mailing address

170 NORTH POINTE BLVD PO BOX 4807
LANCASTER PA
17604-4807
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-4876
  • Fax:
Mailing address:
  • Phone: 717-299-4871
  • Fax: 717-391-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA000840L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMA000840L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: