1275525859 NPI number — DR. ALAN ROY MALOUF MD

Table of content: DR. ALAN ROY MALOUF MD (NPI 1275525859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275525859 NPI number — DR. ALAN ROY MALOUF MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALOUF
Provider First Name:
ALAN
Provider Middle Name:
ROY
Provider Name Prefix Text:
DR.
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:
1275525859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17000 SCIENCE DR
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20715-4431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-805-9200
Provider Business Mailing Address Fax Number:
301-805-9632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17000 SCIENCE DR STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20715-4431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-805-9200
Provider Business Practice Location Address Fax Number:
301-805-9632
Provider Enumeration Date:
08/18/2005

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: 207W00000X , with the licence number:  D0034462 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 22940002 . This is a "BCBS DC INDIVIDUAL ID#" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 20432 . This is a "MAMSI INDIVIDUAL ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 40301606 . This is a "BCBS MD INDIVIDUAL ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 465210 . This is a "AETNA INDIVIDUAL ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 776378 . This is a "UNITED HEALTHCARE ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KW77GE . This is a "BCBS MD GROUP ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 180023952 . This is a "RAILROAD MEDICARE ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 492828 . This is a "HEALTHLINK/NCPPO ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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