Provider Demographics
NPI:1871937003
Name:MAXIMOSS, KARINI A (CRNM)
Entity type:Individual
Prefix:MS
First Name:KARINI
Middle Name:A
Last Name:MAXIMOSS
Suffix:
Gender:F
Credentials:CRNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:560 RIVERSIDE DR
Practice Address - Street 2:SUITE A-204
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4700
Practice Address - Country:US
Practice Address - Phone:410-749-2525
Practice Address - Fax:410-548-5773
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204614207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
MD119591300Medicaid
211872Medicare Oscar/Certification