Provider Demographics
NPI:1225262413
Name:MAXA, ROBERT L (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:MAXA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WOODLAND DR.
Mailing Address - Street 2:
Mailing Address - City:MARIENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16239-0307
Mailing Address - Country:US
Mailing Address - Phone:814-621-2110
Mailing Address - Fax:814-927-7307
Practice Address - Street 1:1 WOODLAND DR.
Practice Address - Street 2:
Practice Address - City:MARIENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16239-0307
Practice Address - Country:US
Practice Address - Phone:814-621-2110
Practice Address - Fax:814-927-7307
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006557L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine