MEDICARE: MARISA MAHER DACM, MSAOM, L.AC

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	171100000X	Acupuncturist	006760	NY

General Provider Information

NPI Number	:	1710632195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA MAHER DACM, MSAOM, L.AC

Provider Business Mailing Address
First Line	:	5016 W GENESEE ST
Second Line	:
City	:	CAMILLUS
State	:	NY
Zip	:	13031-2356
Country	:	US
Telephone Number	:	315-308-0690
Fax Number	:

Provider Business Practice Location Address
First Line	:	5016 W GENESEE ST
Second Line	:
City	:	CAMILLUS
State	:	NY
Zip	:	13031-2356
Country	:	US
Telephone Number	:	315-308-0690
Fax Number	:

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

Provider Enumeration Date	:	02/15/2022
Last Update Date	:	02/15/2022

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