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General NPI Number Information
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NPI Number | 1609005487
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Entity Type | Individual
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Provider Name | AMANDA CAMPBELL MALTRY MD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 6533 DREW AVE S
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City | EDINA
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State | MN
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Zip | 55435-2103
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Country | US
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Telephone | 952-927-7138
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Fax |
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Provider Business Mailing Address
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Address Line | 6533 DREW AVE S
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City | EDINA
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State | MN
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Zip | 55435-2103
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Country | US
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Telephone | 952-927-7138
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Fax |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 58108
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 40912
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License Number State | IA
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