Healthcare Provider Details

I. General information

NPI: 1033146931
Provider Name (Legal Business Name): ROBERT DANIEL MALTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 VILLAGE SQUARE DR SUITE 101
SOUTH KINGSTOWN RI
02879-2292
US

IV. Provider business mailing address

10 DAVOL SQ SUITE 400
PROVIDENCE RI
02903-4754
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-5924
  • Fax: 401-782-1770
Mailing address:
  • Phone: 401-421-4000
  • Fax: 401-272-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7069
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: