Provider Demographics
NPI:1295836286
Name:MALAVE, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MALAVE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACOBUS
Mailing Address - State:PA
Mailing Address - Zip Code:17407
Mailing Address - Country:US
Mailing Address - Phone:717-413-7265
Mailing Address - Fax:
Practice Address - Street 1:2801 E MARKET ST
Practice Address - Street 2:40 WAL MART VISION CENTER
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-600-0856
Practice Address - Fax:717-600-0567
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001302152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA018625200003Medicaid
PA018625200003Medicaid
U58512Medicare UPIN