Provider Demographics
NPI:1093716854
Name:MALOV, STANISLAV (MD)
Entity Type:Individual
Prefix:DR
First Name:STANISLAV
Middle Name:
Last Name:MALOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E GUDE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5307
Mailing Address - Country:US
Mailing Address - Phone:240-777-1680
Mailing Address - Fax:
Practice Address - Street 1:1500 E GUDE DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5307
Practice Address - Country:US
Practice Address - Phone:240-777-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055905207L00000X, 207LP2900X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0055905OtherSTATE LICENSE NUMBER
MD485601500Medicaid
MDH50629SSMedicare PIN
MDG91501Medicare UPIN