MEDICARE: DR. GERALD OSCAR MALKIN DDS

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	207L00000X	Anesthesiology Physician	12001	MA

General Provider Information

NPI Number	:	1265421523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD OSCAR MALKIN DDS

Provider Business Mailing Address
First Line	:	11 OLDE LANTERN RD
Second Line	:
City	:	ACTON
State	:	MA
Zip	:	01720-2011
Country	:	US
Telephone Number	:	978-263-3467
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 OLD ROAD TO 9 ACRE COR
Second Line	:	EMERSON HOSPITAL DEPARTMENT OF ANESTHESIA
City	:	CONCORD
State	:	MA
Zip	:	01742-4159
Country	:	US
Telephone Number	:	978-287-3162
Fax Number	:	978-287-3508

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	11/30/2011

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