Provider Demographics
NPI:1467426296
Name:MALTZMAN, SANDRA H (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:H
Last Name:MALTZMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-0040
Mailing Address - Country:US
Mailing Address - Phone:508-909-7799
Mailing Address - Fax:508-909-7750
Practice Address - Street 1:340 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1509
Practice Address - Country:US
Practice Address - Phone:508-943-5132
Practice Address - Fax:508-943-5209
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226285363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
4143933OtherMVP HEALTH CARE
AA38452OtherHARVARD PILGRIM HEALTHCRE
0706434OtherMEDICAID/WELFARE
8302745OtherEVERCARE
NP5067OtherMEDICARE B
042472266OtherTRICARE CHAMPUS
042472266OtherPRIVATE HLTHCARE SYSTEMS
92685OtherFALLON COMMUNITY HLTH PLN
MA0706434Medicaid
4143933OtherMVP HEALTH CARE