Provider Demographics
NPI:1982649802
Name:ALBERT K MALL MD PC
Entity Type:Organization
Organization Name:ALBERT K MALL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:MALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-262-7980
Mailing Address - Street 1:1111 FRANKLIN ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905
Mailing Address - Country:US
Mailing Address - Phone:814-262-7980
Mailing Address - Fax:814-262-7983
Practice Address - Street 1:1111 FRANKLIN ST
Practice Address - Street 2:SUITE 230
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905
Practice Address - Country:US
Practice Address - Phone:814-262-7980
Practice Address - Fax:814-262-7983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023412E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015110720001Medicaid
PA1772345OtherBCBS
PADE7604OtherRAILROAD MEDICARE
PA096522Medicare PIN