Individual
TINA A MAXIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4433 VESTAL PKWY E, VESTAL, NY 13850-3556
(607) 771-2220
Mailing address
33 LEWIS RD, 2ND FL, BINGHAMTON, NY 13905
(607) 729-8156
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
231462
NY
207X00000X
Orthopaedic Surgery Physician
231462
NY
207XX0801X
Orthopaedic Trauma Physician
017349
ME
207XX0801X
Orthopaedic Trauma Physician
Primary
231462
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02531579
—
NY
Enumeration date
06/16/2005
Last updated
10/05/2016
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