1730170499 NPI number — AMER MALAS MD

Table of content: AMER MALAS MD (NPI 1730170499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730170499 NPI number — AMER MALAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALAS
Provider First Name:
AMER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730170499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 JAMESTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25314-1975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-342-9012
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 JAMESTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25314-1975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-342-9012
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  18266 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: P7948 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0078397000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 335409401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07278616800 . This is a "OHIO BWC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2154761 . This is a "OHIO JOB & FAMILY" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".