MEDICARE: DR. MARILYN MALKIN PHD

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	103T00000X	Psychologist	3385	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	81364	OTHER	OH	QUALCHOICE
2	000000146423	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1245315670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN MALKIN PHD

Provider Business Mailing Address
First Line	:	2460 FAIRMOUNT BLVD
Second Line	:	SUITE 320
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3164
Country	:	US
Telephone Number	:	440-779-6773
Fax Number	:	216-231-7235

Provider Business Practice Location Address
First Line	:	2460 FAIRMOUNT BLVD
Second Line	:	SUITE 320
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3164
Country	:	US
Telephone Number	:	440-779-6773
Fax Number	:	216-231-7235

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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