Provider Demographics
NPI:1972574267
Name:MAIMON, WALTER NED (MD)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:NED
Last Name:MAIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRIAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3429
Mailing Address - Country:US
Mailing Address - Phone:937-299-9331
Mailing Address - Fax:937-496-2610
Practice Address - Street 1:19 BRIAR HILL RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-3429
Practice Address - Country:US
Practice Address - Phone:937-299-9331
Practice Address - Fax:937-496-2610
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045767207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D45767OtherHUMANA
1020053OtherUNITEDHEALTHCARE
OH9125132Medicaid
0640557OtherAETNA
000000003862OtherANTHEM
0640557OtherAETNA
C02885Medicare UPIN
OH9125132Medicaid