DR. MARIO MARUTHUR


Address: 1120 15th St, Augusta, GA 30912-1059
Phone: 7067218623

DR. MARIO MARUTHUR (NPI# 1356738199) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1356738199
Entity Type Individual
Full Name DR. MARIO MARUTHUR
Credential M.D.
Practice Address 1120 15th St
Augusta
GA 30912-1059
Mailing Address 1120 15th St Ste Bi1056
Augusta
GA 30912-0004
Practice Telephone 7067218623
Practice Fax Number 7067211459
Mailing Telephone 7067213813
Enumeration Date 2015-04-20
Last Update Date 2019-05-06
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207N00000X Dermatology 82188 GA Allopathic & Osteopathic Physicians
N 390200000X Student in an Organized Health Care Education/Training Program Student, Health Care

Provider Secondary Practice Location

Address Telephone Number Fax Number
1364 Clifton Rd Ne, Atlanta, GA 303221059 5016207689

Office Location

Street Address 1120 15TH ST
City AUGUSTA
State GA
Zip Code 30912-1059

Providers in the same location

NPI Name Taxonomy Address Enumeration
1427051556 Gyanendra Kumar Sharma Internal Medicine 1120 15th St, Augusta, GA 30912-0004 2005-05-23
1912508532 Lacey Nichol Preston Physician Assistant 1120 15th St, Augusta, GA 30912-0004 2020-11-02
1992302988 Victoria Mae Pregibon Physician Assistant 1120 15th St, Augusta, GA 30912-0004 2020-10-03
1275130239 Tanya Renee Hall Nurse Practitioner 1120 15th St, Augusta, GA 30912-0004 2020-10-02
1144847864 Cassandra Marie Voong Internal Medicine 1120 15th St, Augusta, GA 30912-0004 2020-06-29
1245857002 Morgan Rowe Nurse Practitioner 1120 15th St, Augusta, GA 30912-0004 2020-06-28
1639795990 Lauren Christine Bush Audiologist 1120 15th St, Augusta, GA 30912-0004 2020-06-23
1811513575 Ashley Danielle Fox Internal Medicine 1120 15th St, Augusta, GA 30912-0006 2020-06-18
1265058994 Matthew Craddock Psychiatry & Neurology 1120 15th St, Augusta, GA 30912-0004 2020-06-18
1437775301 Joseph John Arellano Emergency Medicine 1120 15th St, Augusta, GA 30912-0004 2020-06-17
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1548885940 Hannah Gullickson Folsom Family Medicine 1459 Laney Walker Blvd Ae 3042, Augusta, GA 30912 2020-06-11
1487278909 Robert Kennedy Internal Medicine Augusta University Internal Medicine Residency Program, 1120 15th Street, Bi 5070, Augusta, GA 30912 2020-06-01
1952968737 Kayla M. Lasota Pediatrics 11230 115th St Ae3042, Augusta, GA 30912 2019-05-28
1003379280 Kayla Cox Internal Medicine 1120 15th St Bi5070, Augusta, GA 30912 2019-04-13
1619435740 Justin Ray Mackert Student in an Organized Health Care Education/Training Program Augusta University, 1120 15th Street, Gc 5110, Augusta, GA 30912 2019-03-07
1417444167 Victor Celis Dentist John Wesley Gilbert Dr, Augusta, GA 30912 2018-04-18
1487157921 Julie Ann Matsen Student in an Organized Health Care Education/Training Program 997 St. Sebastian Way, Eg-2021-10, Augusta Univ., Dept. of Psychiatry & Health Behavior, Augusta, GA 30912 2018-03-12
1497287031 Luke Yuung-jier Chang Ophthalmology 1120 15th St # Ba2720, Augusta, GA 30912 2017-04-02
1821537622 Lashawn Kay Boone Nurse Practitioner 1445 Harper St, Augusta, GA 30912 2017-02-14
1134675564 Arnab Saha Internal Medicine 1120 15 Th St., Augusta, GA 30912 2016-08-26
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Taxonomy Information

Taxonomy Code 207N00000X
Grouping Allopathic & Osteopathic Physicians
Classification Dermatology

Taxonomy Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1134568520 Matthew Dean Belcher Dermatology 1120 15th St Fl 5, Augusta, GA 30912 2013-06-18
1073822607 Edward Hardin Smith Jr. Dermatology 514 Winchester Dr, Augusta, GA 30909-3236 2010-09-30
1093972325 Jeremiah Allan Miller IIi Dermatology 3624 J. Dewey Gray Circle, Suite 250, Augusta West Dermatology, Augusta, GA 30909 2008-05-22
1225235393 Sarah Josephson Cely Dermatology 820 Saint Sebastian Way Ste 6c, Augusta, GA 30901-2640 2007-07-02
1649349978 Augusta Dermatology Associates PC Dermatology 820 St Sebastian Way Ste 6c, Augusta, GA 30901 2006-11-08
1215923073 Barry L Thompson Dermatology 2060 Central Ave, Augusta, GA 30904-4177 2005-09-26
1437142072 Fred Jason Kight Dermatology 1248 Augusta West Pkwy, Augusta, GA 30909-1854 2005-08-30
1720516560 James Petit Dermatology 1004 Chafee Ave, Augusta, GA 30904 2017-05-24
1801272968 Augusta West Dermatology, LLC Dermatology 3624 J Dewey Gray Cir, Suite 250, Augusta, GA 30909-6584 2015-07-30
1427431048 Rachel Marks Greenwood Dermatology 950 15th St, Augusta, GA 30901-2608 2015-07-01
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Competitor

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City AUGUSTA
Zip Code 30912

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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