Provider Demographics
NPI:1386619054
Name:MALVEHY, MARIO ALBERT (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:ALBERT
Last Name:MALVEHY
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 1:5700 STONERIDGE MALL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2823
Mailing Address - Country:US
Mailing Address - Phone:925-494-0898
Mailing Address - Fax:925-201-3424
Practice Address - Street 1:5700 STONERIDGE MALL RD STE 120
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2823
Practice Address - Country:US
Practice Address - Phone:925-494-0898
Practice Address - Fax:925-201-3424
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 114670207P00000X, 202K00000X
FLME114670208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC134R7OtherBLUE CROSS
NC89134R7Medicaid
NCH91720Medicare UPIN
NC89134R7Medicaid