Provider Demographics
NPI:1144326968
Name:MAHER, MARY BETH L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:L
Last Name:MAHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY BETH
Other - Middle Name:L
Other - Last Name:MAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:235 N PEARL ST GSMC
Mailing Address - Street 2:EXPRESS CARE
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-427-3233
Mailing Address - Fax:
Practice Address - Street 1:325 N PEARL ST GSMC
Practice Address - Street 2:EXPRESS CARE
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-427-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1832363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant