Provider Demographics
NPI:1528313178
Name:MALDIA CONCIERGE CARE LLC
Entity type:Organization
Organization Name:MALDIA CONCIERGE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALDIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-970-8818
Mailing Address - Street 1:1500 URBAN CENTER DR
Mailing Address - Street 2:STE 325
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2564
Mailing Address - Country:US
Mailing Address - Phone:205-970-8818
Mailing Address - Fax:205-259-2118
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:STE 500
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-323-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG75304Medicare PIN