Provider Demographics
NPI:1548472384
Name:MAIA DANIELSON, MD PA
Entity type:Organization
Organization Name:MAIA DANIELSON, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:MAIA
Authorized Official - Middle Name:SERENA
Authorized Official - Last Name:DANIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-428-1922
Mailing Address - Street 1:2224 SOUTH 77 SUNSHINE STRIP
Mailing Address - Street 2:STE #96 PMB #189
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-428-1922
Mailing Address - Fax:956-423-0506
Practice Address - Street 1:1710 ED CAREY DRIVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-428-1922
Practice Address - Fax:956-423-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2210207V00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4862Medicare PIN