Provider Demographics
NPI:1063447266
Name:DAMANI, MALTI P (MD)
Entity Type:Individual
Prefix:
First Name:MALTI
Middle Name:P
Last Name:DAMANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:301 OXFORD VALLEY RD
Mailing Address - Street 2:#202A
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067
Mailing Address - Country:US
Mailing Address - Phone:215-493-9877
Mailing Address - Fax:215-493-3519
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:#202A
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-493-9877
Practice Address - Fax:215-493-3519
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD035007L208000000X
NJ25MA03645300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1116029Medicaid
PA1116029Medicaid