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1003851460 NPI number — MICHAEL MAITLAND M.D., PH.D.

NPI Number: 1003851460
Health Care Provider/Practitioner: MICHAEL MAITLAND M.D., PH.D.

Information about “1003851460” NPI (MICHAEL MAITLAND M.D., PH.D.) exists in 1003851460 in HTML format HTML  |  1003851460 in plain Text format TXT  |  1003851460 in PDF (Portable Document Format) PDF  |  1003851460 in an XML format XML  formats.

NPI Number : 1003851460 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003851460",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAITLAND",
    "FirstName": "MICHAEL",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D., PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "540 N STATE ST",
    "SecondLineMailingAddress": "APT 3111",
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60610-7231",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "312-595-1819",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8081 INNOVATION PARK DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAIRFAX",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22031-4867",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "571-472-4724",
    "PracticeLocationAddressFaxNumber": "571-472-1601",
    "EnumerationDate": "06/19/2006",
    "LastUpdateDate": "11/27/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RX0202X",
          "TaxonomyName": "Medical Oncology Physician",
          "LicenseNumber": "036-109601",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208U00000X",
          "TaxonomyName": "Clinical Pharmacology Physician",
          "LicenseNumber": "036-109601",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RX0202X",
          "TaxonomyName": "Medical Oncology Physician",
          "LicenseNumber": "0101261271",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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