1467426296 NPI number — SANDRA H MALTZMAN NP

Table of content: SANDRA H MALTZMAN NP (NPI 1467426296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467426296 NPI number — SANDRA H MALTZMAN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALTZMAN
Provider First Name:
SANDRA
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467426296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01550-0040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-909-7799
Provider Business Mailing Address Fax Number:
508-909-7750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 THOMPSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01570-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-943-5132
Provider Business Practice Location Address Fax Number:
508-943-5209
Provider Enumeration Date:
02/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  226285 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4143933 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA38452 . This is a "HARVARD PILGRIM HEALTHCRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0706434 . This is a "MEDICAID/WELFARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8302745 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NP5067 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "TRICARE CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "PRIVATE HLTHCARE SYSTEMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 92685 . This is a "FALLON COMMUNITY HLTH PLN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0706434 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com