Provider Demographics
NPI:1477660306
Name:MALKOFF, MARC DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:DAVID
Last Name:MALKOFF
Suffix:
Gender:M
Credentials:MD
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 1000
Mailing Address - Street 2:DEPT # 457
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-448-6198
Mailing Address - Fax:
Practice Address - Street 1:855 MONROE AVE
Practice Address - Street 2:SUITE 415 LINK BUILDING
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-4901
Practice Address - Country:US
Practice Address - Phone:901-448-2625
Practice Address - Fax:901-448-7440
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN513472084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6024333OtherBCBS
TNP01484270OtherRAILROAD MEDICARE
MS00601253Medicaid
AR122553001Medicaid
TNQ005342Medicaid
TNP01484270OtherRAILROAD MEDICARE
TNQ005342Medicaid