MEDICARE: MARIAH MARIE HANEY MEDICAL ASSISTANT

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	207V00000X	Obstetrics & Gynecology Physician	207VG0400X	OH

General Provider Information

NPI Number	:	1669284303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH MARIE HANEY MEDICAL ASSISTANT

Provider Business Mailing Address
First Line	:	1488 CREST RD, CLEVELAND HEIGHTS, OH, USA
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121
Country	:	US
Telephone Number	:	216-644-3048
Fax Number	:

Provider Business Practice Location Address
First Line	:	1488 CREST RD, CLEVELAND HEIGHTS, OH, USA
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121
Country	:	US
Telephone Number	:	216-644-3048
Fax Number	:

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

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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