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NPI Code Detail

MEDICARE: DR. COREY JAMES MAYBERGER M.D.

MEDICARE:  DR. COREY JAMES MAYBERGER  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician24311NE

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1281662OTHERNEMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386723195
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COREY JAMES MAYBERGER M.D.
Provider Business Mailing Address
First Line : 3101 N CENTRAL AVE STE 550
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2635
Country : US
Telephone Number : 602-230-7373
Fax Number :
Provider Business Practice Location Address
First Line : 750 E THUNDERBIRD RD STE 1-3
Second Line :
City : PHOENIX
State : AZ
Zip : 85022-5306
Country : US
Telephone Number : 602-230-7373
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2006
Last Update Date : 10/19/2023

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Directions to “ DR. COREY JAMES MAYBERGER M.D.” Practice Location

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