1760442610 NPI number — CATHERINE S MAXWELL MD

Table of content: CATHERINE S MAXWELL MD (NPI 1760442610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760442610 NPI number — CATHERINE S MAXWELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAXWELL
Provider First Name:
CATHERINE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760442610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 ARCH ST
Provider Second Line Business Mailing Address:
STE. G2
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44304-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-375-4100
Provider Business Mailing Address Fax Number:
330-375-4097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 ARCH ST
Provider Second Line Business Practice Location Address:
STE. G2
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44304-1429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-375-4100
Provider Business Practice Location Address Fax Number:
330-375-4097
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  35-044804 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000132187 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0883123 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0646359 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0405451 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341458069CM . This is a "SUMMA CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 729761 . This is a "BUCKEYE COMMUNITY HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0883122 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 380001328 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4008725 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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