Provider Demographics
NPI:1942418447
Name:RAY, MALIA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:ANNE
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 7TH ST NW STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2666
Mailing Address - Country:US
Mailing Address - Phone:507-242-8746
Mailing Address - Fax:507-204-2117
Practice Address - Street 1:1027 7TH ST NW STE 202
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2666
Practice Address - Country:US
Practice Address - Phone:507-242-8746
Practice Address - Fax:507-204-2117
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 090311207R00000X, 207RC0200X, 207RP1001X
MN59788207R00000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0066510Medicaid
H149210Medicare PIN