MEDICARE: DR. MARIA G. AXELROD 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
1	208000000X	Pediatrics Physician	059367	GA
2	208000000X	Pediatrics Physician	229898	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1558368845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA G. AXELROD MD

Provider Business Mailing Address
First Line	:	910 DANNON VW SW STE 2102
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2156
Country	:	US
Telephone Number	:	404-691-6100
Fax Number	:	404-691-6959

Provider Business Practice Location Address
First Line	:	910 DANNON VW SW STE 2102
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2156
Country	:	US
Telephone Number	:	404-691-6100
Fax Number	:	404-691-6959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/09/2026

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