Provider Demographics
NPI:1235391749
Name:MALENTACCHI, MEGHAN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:MALENTACCHI
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 1:1529 BELLE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1205
Mailing Address - Country:US
Mailing Address - Phone:860-416-0539
Mailing Address - Fax:
Practice Address - Street 1:11340 PEMBROOKE SQ
Practice Address - Street 2:STE 203
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4808
Practice Address - Country:US
Practice Address - Phone:301-932-8776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT50936207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program