Provider Demographics
NPI:1760473763
Name:MAITRA, ARUP (MD)
Entity Type:Individual
Prefix:DR
First Name:ARUP
Middle Name:
Last Name:MAITRA
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 1:2600 TUSCARAWAS ST W
Mailing Address - Street 2:#160
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4644
Mailing Address - Country:US
Mailing Address - Phone:330-454-9126
Mailing Address - Fax:330-454-9470
Practice Address - Street 1:2600 TUSCARAWAS ST W
Practice Address - Street 2:#160
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4644
Practice Address - Country:US
Practice Address - Phone:330-454-9126
Practice Address - Fax:330-454-9470
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3577507174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2162092Medicaid
OH0895701Medicare ID - Type Unspecified
OH2162092Medicaid