Healthcare Provider Details

I. General information

NPI: 1811093198
Provider Name (Legal Business Name): TODD CHRISTOPHER MALVEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E MAIN ST SUITE 208
NORTHBOROUGH MA
01532-1662
US

IV. Provider business mailing address

1 E MAIN ST SUITE 208
NORTHBOROUGH MA
01532-1662
US

V. Phone/Fax

Practice location:
  • Phone: 508-393-0183
  • Fax: 508-393-2310
Mailing address:
  • Phone: 508-393-0183
  • Fax: 508-393-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number836
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: