MEDICARE: DR. VINCENT JOSEPH MALKOVITS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	34006675	OH
2	207R00000X	Internal Medicine Physician	34006675	OH

General Provider Information

NPI Number	:	1104801984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT JOSEPH MALKOVITS D.O.

Provider Business Mailing Address
First Line	:	5533 MAHONING AVE FL 2
Second Line	:
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-2366
Country	:	US
Telephone Number	:	330-793-2701
Fax Number	:	330-793-8688

Provider Business Practice Location Address
First Line	:	5533 MAHONING AVE FL 2
Second Line	:
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-2366
Country	:	US
Telephone Number	:	330-793-2701
Fax Number	:	330-793-8688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	02/07/2022

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