MEDICARE: DR. MAURYA COCKRELL

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1801462486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURYA COCKRELL

Provider Business Mailing Address
First Line	:	222 S MERAMEC AVE # 202-1069
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1805
Country	:	US
Telephone Number	:	314-304-2051
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S MERAMEC AVE # 202-1069
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1805
Country	:	US
Telephone Number	:	314-304-2051
Fax Number	:	314-304-2051

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	06/03/2021

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