Provider Demographics
NPI:1215918156
Name:MAYTAL, GUY (MD)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:
Last Name:MAYTAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 PARKMAN ST
Mailing Address - Street 2:WANG ACC 812
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3117
Mailing Address - Country:US
Mailing Address - Phone:617-724-6300
Mailing Address - Fax:671-186-7541
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WANG ACC 812
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-724-6300
Practice Address - Fax:671-186-7541
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2206942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry