Provider Demographics
NPI:1477671899
Name:MALERICH, PATRICIA G (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:G
Last Name:MALERICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-1707
Mailing Address - Fax:614-293-1716
Practice Address - Street 1:1328 DUBLIN RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1054
Practice Address - Country:US
Practice Address - Phone:614-293-1707
Practice Address - Fax:614-293-1716
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430646207N00000X
OH35.093108207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00755758OtherRAILROAD MEDICARE
OHP00755758OtherRAILROAD MEDICARE
OH000000605859OtherANTHEM BC/BS
OH4258141Medicare PIN