Healthcare Provider Details

I. General information

NPI: 1467426296
Provider Name (Legal Business Name): SANDRA H MALTZMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 THOMPSON RD
WEBSTER MA
01570-1509
US

IV. Provider business mailing address

PO BOX 40
SOUTHBRIDGE MA
01550-0040
US

V. Phone/Fax

Practice location:
  • Phone: 508-943-5132
  • Fax: 508-943-5209
Mailing address:
  • Phone: 508-909-7799
  • Fax: 508-909-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number226285
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: