Provider Demographics
NPI:1598940561
Name:FREDERICK MALIBIRAN DO PA
Entity Type:Organization
Organization Name:FREDERICK MALIBIRAN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIBIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-988-1984
Mailing Address - Street 1:PO BOX 262616
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33685-2616
Mailing Address - Country:US
Mailing Address - Phone:813-988-1984
Mailing Address - Fax:
Practice Address - Street 1:13250 N 56TH ST
Practice Address - Street 2:SUITE #101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1107
Practice Address - Country:US
Practice Address - Phone:813-988-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8108Medicare PIN