MEDICARE: DR. VAIBHAV MAURYA 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	062863	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	062863	OTHER	GA	GEORGIA COMPOSITE MEDICAL BOARD PHYSICIAN LICENSE

General Provider Information

NPI Number	:	1578683447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VAIBHAV MAURYA MD

Provider Business Mailing Address
First Line	:	400 W PEACHTREE ST NW
Second Line	:	SUITE 1106
City	:	ATLANTA
State	:	GA
Zip	:	30308-3546
Country	:	US
Telephone Number	:	706-951-4178
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W PEACHTREE ST NW
Second Line	:	SUITE 1106
City	:	ATLANTA
State	:	GA
Zip	:	30308-3546
Country	:	US
Telephone Number	:	706-951-4178
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	11/11/2009

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