MEDICARE: EAMONN 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207N00000X	Dermatology Physician	71689	MN

General Provider Information

NPI Number	:	1982130746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EAMONN MAHER M.D.

Provider Business Mailing Address
First Line	:	240 PARK AVE UNIT 500
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-2253
Country	:	US
Telephone Number	:	304-993-9960
Fax Number	:	304-691-1695

Provider Business Practice Location Address
First Line	:	516 DELAWARE STREET S.E., MAIL CODE 98
Second Line	:	PHILLIPS-WANGENSTEEN BLDG, SUITE 1-400
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455-3662
Country	:	US
Telephone Number	:	612-625-8625
Fax Number	:	612-624-6678

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	07/08/2022

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