Provider Demographics
NPI:1427013929
Name:MOLTZ, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:MOLTZ
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 1:66 BARIBEAU DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3230
Mailing Address - Country:US
Mailing Address - Phone:207-373-6950
Mailing Address - Fax:207-373-6959
Practice Address - Street 1:66 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3230
Practice Address - Country:US
Practice Address - Phone:207-373-6950
Practice Address - Fax:207-373-6959
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME0129722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM3352Medicare ID - Type Unspecified