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General NPI Number Information
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NPI Number | 1942795349
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Entity Type | Individual
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Provider Name | JACOB THOMAS MAHER MD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 240 INDIAN RIVER RD STE B1
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City | ORANGE
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State | CT
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Zip | 06477
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Country | US
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Telephone | 203-795-6025
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Fax | 203-799-1554
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Provider Business Mailing Address
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Address Line | 240 INDIAN RIVER RD STE B1
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City | ORANGE
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State | CT
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Zip | 06477-3690
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Country | US
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Telephone | 203-795-6025
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Fax | 203-799-1554
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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 | 036160745
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License Number State | IL
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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 | 81218
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License Number State | CT
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