Provider Demographics
NPI:1780673095
Name:MALTA, MATTHEW J (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:MALTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 13830
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4029
Mailing Address - Country:US
Mailing Address - Phone:410-573-2477
Mailing Address - Fax:410-573-2478
Practice Address - Street 1:132 HOLIDAY CT
Practice Address - Street 2:SUITE 201
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7005
Practice Address - Country:US
Practice Address - Phone:410-573-2477
Practice Address - Fax:410-573-2475
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001OtherBCBS
MD483902100Medicaid
998491OtherAETNA HMO
201230000OtherFEDERAL WORKMANS COMP
33305OtherKAISER
08344OtherAMERIGROUP
5994553OtherAETNA
54684902OtherBCBS
54684902OtherBCBS
MD483902100Medicaid
P00639274Medicare PIN