Provider Demographics
NPI:1285706747
Name:SALE, MALCOLM KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:KEITH
Last Name:SALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BALMORAL PL
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2270
Mailing Address - Country:US
Mailing Address - Phone:843-363-2616
Mailing Address - Fax:
Practice Address - Street 1:20 BALMORAL PL
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2270
Practice Address - Country:US
Practice Address - Phone:843-363-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1137581207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000505187009OtherBCBS
NY00468020Medicaid
NY000505187009OtherBCBS
NY00468020Medicaid
NYC58025Medicare UPIN