Healthcare Provider Details

I. General information

NPI: 1326041179
Provider Name (Legal Business Name): JONATHAN MALTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OLNEY SANDY SPRING RD STE 330
OLNEY MD
20832-3305
US

IV. Provider business mailing address

3300 OLNEY SANDY SPRING RD STE 330
OLNEY MD
20832-3305
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-7334
  • Fax: 301-774-7311
Mailing address:
  • Phone: 301-774-7334
  • Fax: 301-774-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberD0021057
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: