Provider Demographics
NPI:1730134263
Name:MALKOSKIE, VIRGINIA ANN (OD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANN
Last Name:MALKOSKIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 STATE ROUTE 61
Mailing Address - Street 2:
Mailing Address - City:COAL TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:17866-4178
Mailing Address - Country:US
Mailing Address - Phone:578-648-8888
Mailing Address - Fax:570-648-8999
Practice Address - Street 1:9300 STATE ROUTE 61
Practice Address - Street 2:
Practice Address - City:COAL TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:17866-4178
Practice Address - Country:US
Practice Address - Phone:570-648-8888
Practice Address - Fax:570-648-8999
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007917T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU75884OtherUPIN
PAU75884OtherUPIN
PA028760Medicare UPIN