Provider Demographics
NPI:1619968492
Name:MALY, GEORGE THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:THOMAS
Last Name:MALY
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 1:3949 SUNFOREST CT
Mailing Address - Street 2:#201
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4473
Mailing Address - Country:US
Mailing Address - Phone:419-475-3635
Mailing Address - Fax:419-476-3376
Practice Address - Street 1:3949 SUNFOREST CT
Practice Address - Street 2:#201
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:419-475-3635
Practice Address - Fax:419-476-3376
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081651207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2511919Medicaid
OHH092151Medicare PIN
OHMA4144882Medicare PIN
OHMA4144882Medicare PIN