Provider Demographics
NPI:1689630766
Name:MALKIN, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:MALKIN
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:ONE LIBERTY SQUARE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051
Mailing Address - Country:US
Mailing Address - Phone:860-229-6811
Mailing Address - Fax:860-224-8088
Practice Address - Street 1:ONE LIBERTY SQUARE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051
Practice Address - Country:US
Practice Address - Phone:860-229-6811
Practice Address - Fax:860-224-8088
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032315207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT032315OtherCTCARE
CT001323154Medicaid
CT50LEXINGTCT01OtherANTHEM
CT001323154Medicaid
A14231Medicare UPIN