Provider Demographics
NPI:1265446520
Name:RIGGS, MALCOLM M (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:M
Last Name:RIGGS
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 1:201 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-1127
Mailing Address - Country:US
Mailing Address - Phone:315-597-8828
Mailing Address - Fax:315-597-8845
Practice Address - Street 1:201 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NY
Practice Address - Zip Code:14522-1127
Practice Address - Country:US
Practice Address - Phone:315-597-8828
Practice Address - Fax:315-597-8845
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194654208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01489298Medicaid
NYCC9139Medicare ID - Type Unspecified
NYF79936Medicare UPIN