Provider Demographics
NPI:1831280676
Name:MALAK, TIMOTHY M (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:M
Last Name:MALAK
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 1:5 HEARTHSTONE CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3055
Mailing Address - Country:US
Mailing Address - Phone:610-370-1790
Mailing Address - Fax:610-370-1886
Practice Address - Street 1:5 HEARTHSTONE CT
Practice Address - Street 2:SUITE 105
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3055
Practice Address - Country:US
Practice Address - Phone:610-370-1790
Practice Address - Fax:610-370-1886
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035440E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011662900005Medicaid
E21911Medicare UPIN
PA0011662900005Medicaid