Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | D0021057 | MD |
NPI | 1326041179 |
---|---|
Provider Name | Jonathan Maltz |
First Address | Olney, MD 20832-3305 |
Second Address | Olney, MD 20832-3305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 16/02/2010 |