Provider Demographics
NPI:1083660047
Name:MAITLAND, ANNE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:L
Last Name:MAITLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:MAITLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MDPHD
Mailing Address - Street 1:55 S BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4000
Mailing Address - Country:US
Mailing Address - Phone:914-631-3283
Mailing Address - Fax:914-631-3284
Practice Address - Street 1:55 S BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4000
Practice Address - Country:US
Practice Address - Phone:914-631-3283
Practice Address - Fax:914-631-3284
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219055207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5N6701Medicare ID - Type Unspecified
NYH77678Medicare UPIN