Provider Demographics
NPI:1902874472
Name:MATTHEW J MALTA MD PA
Entity Type:Organization
Organization Name:MATTHEW J MALTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-573-2477
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:410-573-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M93MJOtherBCBS
MD483902100Medicaid
5719OtherBCBS
DN7942Medicare PIN
121PMedicare PIN