Healthcare Provider Details

I. General information

NPI: 1205868742
Provider Name (Legal Business Name): NEDDA SALEHI MALTBY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NEDDA MOHAMMAD-POUR MD

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 HENRY TECKLENBURG DR
CHARLESTON SC
29414-5733
US

IV. Provider business mailing address

PO BOX 632509
CINCINNATI OH
45263-2509
US

V. Phone/Fax

Practice location:
  • Phone: 843-402-1634
  • Fax: 843-402-1550
Mailing address:
  • Phone: 888-472-0043
  • Fax: 513-653-4122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME101329
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME101329
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number228873
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number96423
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME101329
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: