Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | L1-0044981 | DE |
NPI | 1457029076 |
---|---|
Provider Name | Erin Marie Maynard |
First Address | Smyrna, DE 19977-3981 |
Second Address | Earleville, MD 21919-3008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2021 |
Last Update Date | 30/08/2021 |