Provider Demographics
NPI:1104981372
Name:MALIN, GEORGE ERIC (CAC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ERIC
Last Name:MALIN
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6949 ELMO DRYDEN RD
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21871-3707
Mailing Address - Country:US
Mailing Address - Phone:410-957-3656
Mailing Address - Fax:
Practice Address - Street 1:422 W MARKET ST
Practice Address - Street 2:WORCESTER COUNTY HEALTH DEPARTMENT - MARKET SQUARE
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863-1127
Practice Address - Country:US
Practice Address - Phone:410-632-4510
Practice Address - Fax:410-632-4933
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDACO771101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS013Medicare ID - Type Unspecified