Provider Demographics
NPI:1710979620
Name:MALASPINA, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MALASPINA
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 1:44 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2768
Mailing Address - Country:US
Mailing Address - Phone:724-689-1335
Mailing Address - Fax:724-689-1337
Practice Address - Street 1:44 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2768
Practice Address - Country:US
Practice Address - Phone:724-689-1335
Practice Address - Fax:724-689-1337
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060540L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017568220006Medicaid
NY01984321OtherNY MEDICAL ASSISTANCE
PA589773OtherBLUE SHIELD
PA127240OtherUNISON
PA0017568220006Medicaid
OH2229752OtherOH MEDICAL ASSISTANCE
PA2588267OtherAETNA
NY01984321OtherNY MEDICAL ASSISTANCE
WV1068875OtherWEST VIRGINIA WORK COMP
PA212616OtherUPMC
PA020049996OtherRR MEDICARE
G96260Medicare UPIN
PA212616OtherUPMC