Provider Demographics
NPI:1336121912
Name:MAAS, KURT DALEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:DALEN
Last Name:MAAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9001
Mailing Address - Country:US
Mailing Address - Phone:570-675-8730
Mailing Address - Fax:570-675-7771
Practice Address - Street 1:609 MAIN RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9001
Practice Address - Country:US
Practice Address - Phone:570-675-8730
Practice Address - Fax:570-675-7771
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029909E207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009592120007Medicaid
PA71789Medicare ID - Type Unspecified
PA0009592120007Medicaid