Healthcare Provider Details

I. General information

NPI: 1326284134
Provider Name (Legal Business Name): JAMES PATRICK MAURER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORRIS STREET, SUITE 201
CHARLESTON WV
25301
US

IV. Provider business mailing address

415 MORRIS ST 201
CHARLESTON WV
25301-1853
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7700
  • Fax: 304-388-7755
Mailing address:
  • Phone: 304-388-7700
  • Fax: 304-388-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS013454
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number2459
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: