Provider Demographics
NPI:1285602771
Name:MALAQUIAS, STEPHEN W (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:MALAQUIAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25 COMMUNICATIONS WAY
Mailing Address - Street 2:MACC - REVENUE CYCLE
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1866
Mailing Address - Country:US
Mailing Address - Phone:508-957-8664
Mailing Address - Fax:508-957-8677
Practice Address - Street 1:257 STATION AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664
Practice Address - Country:US
Practice Address - Phone:508-394-8303
Practice Address - Fax:508-398-6680
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA40224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2061619Medicaid
MA6832OtherHPHC
MAL15111OtherBCBS
MA2061619Medicaid
MAL15111Medicare ID - Type Unspecified