Provider Demographics
NPI:1821451303
Name:MAITRE, JEAN-BAPTISTE ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JEAN-BAPTISTE
Middle Name:ROBERT
Last Name:MAITRE
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 1:1701 N GEORGE MASON DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3610
Mailing Address - Country:US
Mailing Address - Phone:240-686-2300
Mailing Address - Fax:240-780-7805
Practice Address - Street 1:1701 N GEORGE MASON DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3610
Practice Address - Country:US
Practice Address - Phone:240-686-2300
Practice Address - Fax:240-780-7805
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101266383207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101266383OtherVA DHP MEDICAL LICENSE