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General NPI Number Information
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NPI Number | 1144224999
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Entity Type | Individual
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Provider Name | MAIA S MCCUISTON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 106 IRVING ST NW STE 2300
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City | WASHINGTON
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State | DC
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Zip | 20010-2959
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Country | US
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Telephone | 202-291-6257
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Fax |
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Provider Business Mailing Address
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Address Line | 106 IRVING ST NW STE 218
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City | WASHINGTON
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State | DC
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Zip | 20010-2993
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Country | US
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Telephone | 734-972-4571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD039436
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101236606
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D72871
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License Number State | MD
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