Provider Demographics
NPI:1588803647
Name:MALCHIKOV, MARK
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:MALCHIKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 CAPTAIN EAMES CIR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-3915
Mailing Address - Country:US
Mailing Address - Phone:718-825-4711
Mailing Address - Fax:
Practice Address - Street 1:169 CAPTAIN EAMES CIR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-3915
Practice Address - Country:US
Practice Address - Phone:718-825-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C1101XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiovascular-Interventional Technology