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General NPI Number Information
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NPI Number | 1720065295
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Entity Type | Individual
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Provider Name | STEPHEN MATURO MD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 05/24/2019
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Provider Practice Location Address
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Address Line | 1250 FOREST AVE STE 301
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City | PORTLAND
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State | ME
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Zip | 04103-1884
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Country | US
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Telephone | 207-797-5753
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Fax | 207-797-9571
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Provider Business Mailing Address
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Address Line | 3851 ROGER BROOKE DR BROOKE ARMY MEDICAL CENTER/ MCHE-QD/CREDENTIALS
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4501
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Country | US
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Telephone | 210-916-2504
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Fax | 210-916-1247
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 01056203A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | P0440
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD22447
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License Number State | ME
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