Healthcare Provider Details

I. General information

NPI: 1700874989
Provider Name (Legal Business Name): ROBERT MALTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10496 MONTGOMERY RD STE. 206
CINCINNATI OH
45242-5223
US

IV. Provider business mailing address

PO BOX 640716
CINCINNATI OH
45264-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-1190
  • Fax:
Mailing address:
  • Phone: 800-357-5728
  • Fax: 937-291-2962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35026004
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: