Provider Demographics
NPI:1285693077
Name:MAXWELL, MARIUS (MD)
Entity type:Individual
Prefix:
First Name:MARIUS
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 LAKE OTIS PARKWAY, STE 202
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-0000
Mailing Address - Country:US
Mailing Address - Phone:907-222-6500
Mailing Address - Fax:907-222-6550
Practice Address - Street 1:3650 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5218
Practice Address - Country:US
Practice Address - Phone:907-222-6500
Practice Address - Fax:907-222-6550
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5262207T00000X
NMMD2011-0824207T00000X
AK7202207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6100890Medicaid
WY119113600Medicaid
WY312588OtherWYOMING BCBS PIN
ND24245OtherND BCBS PIN
SD4995818OtherWELLMARK BCBS PIN
MT3505619Medicaid
WYW10091Medicare PIN
P00093242Medicare PIN
SDS41802Medicare PIN
ND24245OtherND BCBS PIN
WY119113600Medicaid
NMNMA101967Medicare PIN