Provider Demographics
NPI:1689672016
Name:MALDIN, RICHARD ARTHUR (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ARTHUR
Last Name:MALDIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6016
Mailing Address - Country:US
Mailing Address - Phone:203-255-4618
Mailing Address - Fax:203-268-2299
Practice Address - Street 1:1305 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6016
Practice Address - Country:US
Practice Address - Phone:203-255-4618
Practice Address - Fax:203-268-2299
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000117213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT030000117CT01OtherCT. BLUE SHIELD
CT000955OtherHEALTH NET
CT4006003Medicaid
T22060Medicare UPIN