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General NPI Number Information
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NPI Number | 1558381251
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Entity Type | Individual
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Provider Name | EDWARD A MAITZ PHD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 117 S 17TH ST SUITE 1700
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City | PHILADELPHIA
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State | PA
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Zip | 19103-5025
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Country | US
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Telephone | 215-864-9444
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Fax | 215-864-0244
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Provider Business Mailing Address
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Address Line | 117 S 17TH ST SUITE 1700
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City | PHILADELPHIA
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State | PA
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Zip | 19103-5025
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Country | US
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Telephone | 215-864-9444
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Fax | 215-864-0244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 004599L
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License Number State | PA
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