Provider Demographics
NPI:1598083537
Name:MAITTA, ROBERT W (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:MAITTA
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:UNIVERSITY HOSPITALS CASE MEDICAL CENTER
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-15
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-097642207ZC0500X, 207ZP0104X, 207ZH0000X, 207ZI0100X, 207ZD0900X, 207ZP0105X, 207ZF0201X, 207ZM0300X
OH35.097642207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPO1063588OtherRAILROAD MEDICARE
OH0053614Medicaid
OH0053614Medicaid