Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | 35120780 | OH |
Y | 2080P0206X | Pediatric Gastroenterologist | 35120780 | OH |
NPI | 1205148954 |
---|---|
Provider Name | Dr. Ross Mathew Maltz |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205-2664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2010 |
Last Update Date | 24/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0123810 | (05) | OH |