=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114019163
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA CHIRINO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 11/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 WILLIAMSON ST
-----------------------------------------------------
City | ELIZABETH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07202-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-994-5000
-----------------------------------------------------
Fax | 908-994-5805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3114 CROASDAILE DR SUITE 200
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27705-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-425-1565
-----------------------------------------------------
Fax | 919-425-0478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 25MA05365500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 25MA05365500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------