Provider Demographics
NPI:1316988942
Name:MALKIN, RICHARD I (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:I
Last Name:MALKIN
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:P. O. BOX 8500 - 6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:9501 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1025
Practice Address - Country:US
Practice Address - Phone:215-969-4917
Practice Address - Fax:215-969-5875
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020683E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00728260-02OtherAMERICHOICE
PA025071OtherHIGHMARK BLUE SHIELD
PA877298OtherUNITED HEALTHCARE
PA1591648OtherFIRST HEALTH
PA1506795OtherPHCS
PA03226OtherHEALTH PARTNERS
PA1022046OtherKEYSTONE MERCY
PA1072645OtherCIGNA
PA298OtherAETNA
PAPA0043691OtherTRICARE
PA025071OtherPERSONAL CHOICE
PA1072645OtherCIGNA
PA00728260-02OtherAMERICHOICE