Provider Demographics
NPI:1376690438
Name:MALVASI, PHILLIP PAUL (DO)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:PAUL
Last Name:MALVASI
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 1:1017 YOUNGSTOWN WARREN RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4620
Mailing Address - Country:US
Mailing Address - Phone:330-544-5600
Mailing Address - Fax:330-544-5550
Practice Address - Street 1:1017 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4620
Practice Address - Country:US
Practice Address - Phone:330-544-5600
Practice Address - Fax:330-544-5550
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007005M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2100292Medicaid
OH2100292Medicaid
OHMA0869722Medicare ID - Type Unspecified