Healthcare Provider Details

I. General information

NPI: 1972574267
Provider Name (Legal Business Name): WALTER NED MAIMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRIAR HILL RD
DAYTON OH
45419-3429
US

IV. Provider business mailing address

19 BRIAR HILL RD
DAYTON OH
45419-3429
US

V. Phone/Fax

Practice location:
  • Phone: 937-299-9331
  • Fax: 937-496-2610
Mailing address:
  • Phone: 937-299-9331
  • Fax: 937-496-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35045767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: