Provider Demographics
NPI:1497746382
Name:MALAKIS, NICHOLAS H (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:H
Last Name:MALAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE #235
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-266-2770
Mailing Address - Fax:410-841-6251
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE #235
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-2770
Practice Address - Fax:410-841-6251
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00237922085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01780A09OtherAAD PG COUNTY
MD10690025OtherBCBS
MDC562OtherAAD AA COUNTY
MD2622593OtherAETNA HMO/POS
MD310081200Medicaid
MD8317071OtherAETNA PPO
MDC561OtherAAD SHIPLEYS
MD310081200Medicaid
MD10690025OtherBCBS
MD2622593OtherAETNA HMO/POS
MDC562OtherAAD AA COUNTY
MDS629C459Medicare ID - Type Unspecified
MD300135414Medicare PIN