Provider Demographics
NPI:1588627681
Name:MALEH, DAVID JACK (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JACK
Last Name:MALEH
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 1:410 FOULK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3820
Mailing Address - Country:US
Mailing Address - Phone:302-762-2820
Mailing Address - Fax:302-762-9204
Practice Address - Street 1:410 FOULK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3820
Practice Address - Country:US
Practice Address - Phone:302-762-2820
Practice Address - Fax:302-762-9204
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001040401Medicaid
DEH23702Medicare UPIN
DE492031Medicare PIN