Provider Demographics
NPI:1023014230
Name:IYER, MALINI (MD, FACS, FRCS)
Entity Type:Individual
Prefix:
First Name:MALINI
Middle Name:
Last Name:IYER
Suffix:
Gender:F
Credentials:MD, FACS, FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 2ND STREET PIKE STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3829
Mailing Address - Country:US
Mailing Address - Phone:215-633-3456
Mailing Address - Fax:215-396-3456
Practice Address - Street 1:45 2ND STREET PIKE STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3829
Practice Address - Country:US
Practice Address - Phone:215-633-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039231208600000X
NJ25MA08874200208600000X
PAMD436759208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7906347OtherAETNA
NJ60174432OtherHORIZON NJ HEALTH
NJP01604147OtherRR MEDICARE
NJ03367502OtherAMERIGROUP
FL2400692OtherCIGNA
NJ1400299OtherCOVENTRY
NJP5369907OtherUNTIED
NJP01604147OtherRR MEDICARE