=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831597954
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID J MALEH, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2014
-----------------------------------------------------
Last Update Date | 05/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 FOULK RD SUITE 100
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19803-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-762-2820
-----------------------------------------------------
Fax | 302-762-9204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 FOULK RD SUITE 100
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19803-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-762-2820
-----------------------------------------------------
Fax | 302-762-9204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID J MALEH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 302-762-2820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------