Provider Demographics
NPI:1306826672
Name:MALAMUD, LEONARD M (DO)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:M
Last Name:MALAMUD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-946-3100
Mailing Address - Fax:215-946-9965
Practice Address - Street 1:44 SWEETBRIAR LANE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-2226
Practice Address - Country:US
Practice Address - Phone:215-946-3100
Practice Address - Fax:215-946-9965
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004622L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22110OS004622LOtherHEALTH PARTNERS
PA0022672000OtherKEYSTONE IBC
PA0008981710001Medicaid
PA100398Medicaid
PA30071625OtherKEYSTONE MERCY
PA98932OtherAETNA HMO
PA184188OtherHIGHMARK BLUE SHIELD
PA22110OS004622LOtherHEALTH PARTNERS
PA184188OtherHIGHMARK BLUE SHIELD
PA100398Medicaid