Provider Demographics
NPI:1285825364
Name:DR MALCOLM I PRICE
Entity Type:Organization
Organization Name:DR MALCOLM I PRICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:I
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-343-9280
Mailing Address - Street 1:79 PRICHARD ST
Mailing Address - Street 2:PO BOX 2380
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3247
Mailing Address - Country:US
Mailing Address - Phone:978-343-9280
Mailing Address - Fax:978-342-0630
Practice Address - Street 1:79 PRICHARD ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-3247
Practice Address - Country:US
Practice Address - Phone:978-343-9280
Practice Address - Fax:978-342-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1356213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0313173Medicaid
MA0313173Medicaid