Provider Demographics
NPI:1992112130
Name:GEROGE S MALOUF M.D., P.A.
Entity type:Organization
Organization Name:GEROGE S MALOUF M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-423-5252
Mailing Address - Street 1:4400 TELFAIR BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-5217
Mailing Address - Country:US
Mailing Address - Phone:301-423-5252
Mailing Address - Fax:301-423-2414
Practice Address - Street 1:4400 TELFAIR BLVD STE D
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-5217
Practice Address - Country:US
Practice Address - Phone:301-423-5252
Practice Address - Fax:301-423-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
512520Medicare PIN