Healthcare Provider Details

I. General information

NPI: 1548234743
Provider Name (Legal Business Name): MARY C MAIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 NW MYHRE PL
SILVERDALE WA
98383-8561
US

IV. Provider business mailing address

2512 WHEATON WAY
BREMERTON WA
98310-3399
US

V. Phone/Fax

Practice location:
  • Phone: 360-830-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMM069013
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD00028443
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: