Healthcare Provider Details

I. General information

NPI: 1548257744
Provider Name (Legal Business Name): MALINA K MILAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOYLSTON ST SUITE 204
CHESTNUT HILL MA
02467-1715
US

IV. Provider business mailing address

3 CANAVAN CIR
NEEDHAM MA
02492-1143
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-0400
  • Fax: 617-754-0425
Mailing address:
  • Phone: 781-449-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number202786
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: