Provider Demographics
NPI:1194938738
Name:MALLHI, MOIN U (MD)
Entity type:Individual
Prefix:
First Name:MOIN
Middle Name:U
Last Name:MALLHI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 FREAS AVE
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-1612
Mailing Address - Country:US
Mailing Address - Phone:570-752-6441
Mailing Address - Fax:570-752-6442
Practice Address - Street 1:1200 FREAS AVE
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-1612
Practice Address - Country:US
Practice Address - Phone:570-752-6441
Practice Address - Fax:570-752-6442
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055799L174400000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019733140008Medicaid
PA066024SCOMedicare ID - Type UnspecifiedMEDICARE
PA0019733140008Medicaid