=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598083537
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT W. MAITTA M.D.,PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2010
-----------------------------------------------------
Last Update Date | 03/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11100 EUCLID AVE UNIVERSITY HOSPITALS CASE MEDICAL CENTER
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44106-1716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-844-4897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24701 EUCLID AVE 3RD FLOOR
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44117-1714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZC0500X
-----------------------------------------------------
Taxonomy Name | Cytopathology Physician
-----------------------------------------------------
License Number | 35-097642
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZB0001X
-----------------------------------------------------
Taxonomy Name | Blood Banking & Transfusion Medicine Physician
-----------------------------------------------------
License Number | 35.097642
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207ZP0104X
-----------------------------------------------------
Taxonomy Name | Chemical Pathology Physician
-----------------------------------------------------
License Number | 35-097642
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207ZH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Pathology) Physician
-----------------------------------------------------
License Number | 35-097642
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207ZI0100X
-----------------------------------------------------
Taxonomy Name | Immunopathology Physician
-----------------------------------------------------
License Number | 35-097642
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 207ZD0900X
-----------------------------------------------------
Taxonomy Name | Dermatopathology (Pathology) Physician
-----------------------------------------------------
License Number | 35-097642
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 207ZP0105X
-----------------------------------------------------
Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
-----------------------------------------------------
License Number | 35-097642
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 207ZF0201X
-----------------------------------------------------
Taxonomy Name | Forensic Pathology Physician
-----------------------------------------------------
License Number | 35-097642
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 207ZM0300X
-----------------------------------------------------
Taxonomy Name | Medical Microbiology Physician
-----------------------------------------------------
License Number | 35-097642
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------