Active NPI
Brian Thomas Maurer, PA
- Physician Assistant
- Enfield, CT
National Provider Identifier
1982672564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 000073
- Practice address
- 155 Hazard Ave
Suite 14
Enfield, CT 06082-4580 - Phone
- (860) 749-3169
- Fax
- (860) 749-2670
- NPI assigned
- Mar 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 000073 | CT | Primary |
Addresses
Primary practice location
155 Hazard Ave
Suite 14
Enfield, CT 06082-4580
Mailing address
19 Maple St
Tariffville, CT 06081-9636
Phone (860) 651-9940
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008036364 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000073 | CT | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377993600000",
"number": "1982672564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 MAPLE ST",
"city": "TARIFFVILLE",
"state": "CT",
"postal_code": "060819636",
"telephone_number": "860-651-9940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 HAZARD AVE",
"address_2": "SUITE 14",
"city": "ENFIELD",
"state": "CT",
"postal_code": "060824580",
"telephone_number": "860-749-3169",
"fax_number": "860-749-2670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAURER",
"first_name": "BRIAN",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-09",
"last_updated": "2013-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CT",
"license": "000073",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008036364",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Enfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.