Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | D0029555 | MD |
NPI | 1245246958 |
---|---|
Provider Name | Dr. Paul M Mauriello |
First Address | Hagerstown, MD 21740-5857 |
Second Address | Hagerstown, MD 21740-5857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 09/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
462641901 | (05) | MD |
B66921 | (02) | MD |