Provider Demographics
NPI:1275847667
Name:MALCOLM H GINNIS MD PA
Entity Type:Organization
Organization Name:MALCOLM H GINNIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:GINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-426-2373
Mailing Address - Street 1:1500 E HILLSBORO BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4355
Mailing Address - Country:US
Mailing Address - Phone:954-426-1080
Mailing Address - Fax:954-698-0623
Practice Address - Street 1:1500 E HILLSBORO BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4355
Practice Address - Country:US
Practice Address - Phone:954-426-1080
Practice Address - Fax:954-698-0623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0017005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21131Medicare UPIN
FL06956Medicare PIN