Healthcare Provider Details

I. General information

NPI: 1437292992
Provider Name (Legal Business Name): MALINI A. MUDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 STERIGERE ST NORRISTOWN STATE HOSPITAL
NORRISTOWN PA
19401-5300
US

IV. Provider business mailing address

21 WINDSOR CIR
LOWER GWYNEDD PA
19002-2067
US

V. Phone/Fax

Practice location:
  • Phone: 610-313-5645
  • Fax: 610-313-1013
Mailing address:
  • Phone: 215-654-1479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD-035559-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: