Individual
MATTHEW DEAN MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
830 WASHINGTON ST, WATERTOWN, NY 13601-4034
(315) 786-4813
Mailing address
830 WASHINGTON ST, WATERTOWN, NY 13601-4034
(315) 779-5244
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
269418
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03983768
—
NY
Enumeration date
05/31/2011
Last updated
03/26/2018
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