Provider Demographics
NPI:1710900188
Name:YOUNG, REBECA YAEL MALAMUD (MD)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:YAEL MALAMUD
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECA
Other - Middle Name:YAEL
Other - Last Name:MALAMUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITLA OF PHILADELPHIA - EMERGENCY MED
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1944
Practice Address - Fax:215-590-4454
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418744208000000X, 2080P0204X
NJ25MA076046002080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001895890Medicaid
NJ8840601Medicaid
NJ8840601Medicaid
PA001895890Medicaid