1285602771 NPI number — STEPHEN W MALAQUIAS MD

Table of content: STEPHEN W MALAQUIAS MD (NPI 1285602771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285602771 NPI number — STEPHEN W MALAQUIAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALAQUIAS
Provider First Name:
STEPHEN
Provider Middle Name:
W
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:
1285602771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 COMMUNICATIONS WAY
Provider Second Line Business Mailing Address:
MACC - REVENUE CYCLE
Provider Business Mailing Address City Name:
HYANNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02601-1866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-957-8664
Provider Business Mailing Address Fax Number:
508-957-8677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
257 STATION AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH YARMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-394-8303
Provider Business Practice Location Address Fax Number:
508-398-6680
Provider Enumeration Date:
03/09/2006

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:  40224 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2061619 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6832 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: L15111 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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