Healthcare Provider Details

I. General information

NPI: 1205945995
Provider Name (Legal Business Name): AMY LOUISE MAHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 POINT FOSDICK DR
GIG HARBOR WA
98335-1711
US

IV. Provider business mailing address

4810 POINT FOSDICK DR STE 92
GIG HARBOR WA
98335-1711
US

V. Phone/Fax

Practice location:
  • Phone: 541-816-7336
  • Fax:
Mailing address:
  • Phone: 253-356-7477
  • Fax: 888-782-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number61303508
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number4301507227
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number4393
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberA86866
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number67051
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number0071050
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberMC2148
License Number StateID
# 8
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberMD166757
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: