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NPI Code Detail

MEDICARE: ERICA ANN MAILLER MD

MEDICARE: ERICA ANN MAILLER MD
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
1207N00000XDermatology PhysicianME 105564FL
2207ND0101XMOHS-Micrographic Surgery PhysicianME 105564FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000567662OTHERANTHEM

General Provider Information

NPI Number : 1508077801
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA ANN MAILLER MD
Provider Business Mailing Address
First Line : 7335 W SAND LAKE RD STE 200
Second Line :
City : ORLANDO
State : FL
Zip : 32819-5539
Country : US
Telephone Number : 407-352-8553
Fax Number : 407-351-8412
Provider Business Practice Location Address
First Line : 7335 W SAND LAKE RD STE 200
Second Line :
City : ORLANDO
State : FL
Zip : 32819-5539
Country : US
Telephone Number : 407-352-8553
Fax Number : 407-351-8412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2007
Last Update Date : 11/27/2023

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