MEDICARE: MIRIAM R MAHER M.D.

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	207R00000X	Internal Medicine Physician	25MA06816700	NJ
2	208000000X	Pediatrics Physician	25MA06816700	NJ

General Provider Information

NPI Number	:	1780689554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM R MAHER M.D.

Provider Business Mailing Address
First Line	:	130 N BEVERWYCK RD
Second Line	:
City	:	LAKE HIAWATHA
State	:	NJ
Zip	:	07034-1909
Country	:	US
Telephone Number	:	973-335-1065
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 N BEVERWYCK RD
Second Line	:
City	:	LAKE HIAWATHA
State	:	NJ
Zip	:	07034-1909
Country	:	US
Telephone Number	:	973-335-1065
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	05/27/2010

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Directions to “ MIRIAM R MAHER M.D.” Practice Location

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