Provider Demographics
NPI:1043383847
Name:MALIN, MAUREEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:A
Last Name:MALIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1041
Mailing Address - Country:US
Mailing Address - Phone:978-464-2141
Mailing Address - Fax:
Practice Address - Street 1:MCLEAN CENTER AT FERNSIDE
Practice Address - Street 2:162 MOUNTAIN ROAD
Practice Address - City:PRINCETON
Practice Address - State:MA
Practice Address - Zip Code:01541
Practice Address - Country:US
Practice Address - Phone:978-464-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA569982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ06654OtherBCBS
MAJ06654OtherBCBS
B98050Medicare UPIN