Robert Daniel Maltz, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

7069 Issued in RI

Practice address

65 Village Square Dr
Suite 101
South Kingstown, RI 02879-2292

Phone

(401) 789-5924

Fax

(401) 782-1770

NPI assigned

Jun 27, 2006

Last updated

Jan 18, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coastal Medical Physicians, Inc.

  dba Brown Health Medical Group Primary Care

  • Internal Medicine Physician
  • Riverside, RI
  • NPI 1093678104
  NPD
• Coastal Medical Physicians, Inc.

  dba Brown Health Medical Group Primary Care

  • Internal Medicine Physician
  • Providence, RI
  • NPI 1780273540

  Pediatrics

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453075200000",
    "number": "1033146931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DAVOL SQ",
            "address_2": "SUITE 400",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034754",
            "telephone_number": "401-421-4000",
            "fax_number": "401-272-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 VILLAGE SQUARE DR",
            "address_2": "SUITE 101",
            "city": "SOUTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028792292",
            "telephone_number": "401-789-5924",
            "fax_number": "401-782-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALTZ",
        "first_name": "ROBERT",
        "middle_name": "DANIEL",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2016-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "RI",
            "license": "7069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "710054201",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "1893",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH",
            "identifier": "1200223",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RM04043",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "004050",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Inner Balance of Ri
• Shelly Johnson, MD
• Agnieszka Kendall, MD
• Amanda Nicole Kilgallon, PMHNP, APRN
• Durga S. Larkin, M.D.
• Donna Marie Massey, LMHC
• Melissa McHugh, MD
• Metanoia Therapy and Wellness, LLC
• Rachel F Mikutel, PMHNP-BC
• Camille M Moonsammy, NURSE PRACTITIONER

• Pediatrics Physician in South Kingstown, RI
• Providers in South Kingstown, RI by specialty
• Pediatrics Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.