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General NPI Number Information
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NPI Number | 1831404334
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Entity Type | Individual
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Provider Name | HADJI MAGNAYE MALACAS PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 11/27/2014
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Provider Practice Location Address
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Address Line | 5601 LOCH RAVEN BLVD
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City | BALTIMORE
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State | MD
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Zip | 21239-2945
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Country | US
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Telephone | 443-444-4040
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Fax |
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Provider Business Mailing Address
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Address Line | 5204 CATALPHA RD
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City | BALTIMORE
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State | MD
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Zip | 21214-2101
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Country | US
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Telephone | 443-824-4949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0004207
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License Number State | MD
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