Provider Demographics
NPI:1033146931
Name:MALTZ, ROBERT DANIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DANIEL
Last Name:MALTZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:65 VILLAGE SQUARE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-2292
Practice Address - Country:US
Practice Address - Phone:401-789-5924
Practice Address - Fax:401-782-1770
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RI7069208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1893OtherNEIGHBORHOOD HEALTH PLAN
1200223OtherUNITED HEALTH
710054201OtherCIGNA
RIRM04043Medicaid
004050OtherBLUE CHIP
710054201OtherCIGNA