MEDICARE: MS. MARY MAIORANO NP-C

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	363LF0000X	Family Nurse Practitioner	1243	AK
2	363LF0000X	Family Nurse Practitioner	005206	CT

General Provider Information

NPI Number	:	1720362577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY MAIORANO NP-C

Provider Business Mailing Address
First Line	:	156 MUSIC VALE RD
Second Line	:
City	:	SALEM
State	:	CT
Zip	:	06420-3824
Country	:	US
Telephone Number	:	860-984-9646
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 BOSTON TPKE
Second Line	:
City	:	COVENTRY
State	:	CT
Zip	:	06238-1105
Country	:	US
Telephone Number	:	860-742-9050
Fax Number	:	860-742-9097

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

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	06/03/2014

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