Provider Demographics
NPI:1306937180
Name:GEORGE T MALY MD, LLC
Entity type:Organization
Organization Name:GEORGE T MALY MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-475-3635
Mailing Address - Street 1:3949 SUNFOREST CT
Mailing Address - Street 2:SUITE #201
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4473
Mailing Address - Country:US
Mailing Address - Phone:419-475-3635
Mailing Address - Fax:419-475-3376
Practice Address - Street 1:3949 SUNFOREST CT
Practice Address - Street 2:SUITE #201
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4473
Practice Address - Country:US
Practice Address - Phone:419-475-3635
Practice Address - Fax:419-475-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081651207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2761533Medicaid
OH2761533Medicaid