Provider Demographics
NPI:1215972773
Name:MALKASIAN, LUCY B (MD)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:B
Last Name:MALKASIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:B
Other - Last Name:MESROBIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:275 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4655
Mailing Address - Country:US
Mailing Address - Phone:701-642-2000
Mailing Address - Fax:701-671-4106
Practice Address - Street 1:275 11TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4655
Practice Address - Country:US
Practice Address - Phone:701-642-2000
Practice Address - Fax:701-671-4106
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4761208000000X
MN27260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND142036OtherUCARE #
ND7775590Medicaid
NDDA9051015636OtherPREFERRED ONE #
NDHP19525OtherHEALTHPARTNERS #
ND30657OtherSIOUX VALLEY #
ND103062100Medicaid
ND2495OtherNDBS #
ND2724OtherNDBS #
NDND100017OtherLHS #
ND1201182OtherMEDICA #
ND14103Medicaid
ND676668OtherAMERICA'S PPO/ARAZ #
ND93114MAOtherMNBS #
ND93114MAOtherMNBS #
ND2724Medicare ID - Type UnspecifiedND MEDICARE #
ND7775590Medicaid