Provider Demographics
NPI:1588778450
Name:DRS MAURIELLO AND ORFAN PA
Entity type:Organization
Organization Name:DRS MAURIELLO AND ORFAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-790-1482
Mailing Address - Street 1:1125 DIAMOND DR STE B
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5857
Mailing Address - Country:US
Mailing Address - Phone:301-790-1482
Mailing Address - Fax:301-790-1377
Practice Address - Street 1:1125 DIAMOND DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5857
Practice Address - Country:US
Practice Address - Phone:301-790-1482
Practice Address - Fax:301-790-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD761400400Medicaid
MD531LMedicare ID - Type Unspecified