1760463574 NPI number — DR. JOSEPH JOHN MALJOVEC M.D.

Table of content: DR. JOSEPH JOHN MALJOVEC M.D. (NPI 1760463574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760463574 NPI number — DR. JOSEPH JOHN MALJOVEC M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALJOVEC
Provider First Name:
JOSEPH
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALJOVEC
Provider Other First Name:
JOHN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760463574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 PLUMBER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16365-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-723-2323
Provider Business Mailing Address Fax Number:
814-726-3337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 PLUMBER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16365-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-723-2323
Provider Business Practice Location Address Fax Number:
814-726-3337
Provider Enumeration Date:
11/09/2005

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: 174400000X , with the licence number:  MD023842E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: MD023842E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0009405150010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0009405150003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104179 . This is a "UNISON/MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00025102301 . This is a "UNIVERA HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 219414 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 051052 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 160039919 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 89086 . This is a "GHI HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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