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NPI Code Detail

MEDICARE: GREGORY J MARONEY PA-C

MEDICARE:   GREGORY J MARONEY  PA-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
1363AM0700XMedical Physician AssistantPA2003-0005NM

General Provider Information

NPI Number : 1972550184
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY J MARONEY PA-C
Provider Business Mailing Address
First Line : 12127B HWY 14N SUITE 5
Second Line :
City : CEDAR CREST
State : NM
Zip : 87008-9499
Country : US
Telephone Number : 505-281-5180
Fax Number : 505-281-5320
Provider Business Practice Location Address
First Line : 1108 W US ROUTE 66
Second Line :
City : MORIARTY
State : NM
Zip : 87035-1006
Country : US
Telephone Number : 505-832-4434
Fax Number : 505-832-5024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2006
Last Update Date : 04/05/2018

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Directions to “ GREGORY J MARONEY PA-C” Practice Location

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