Provider Demographics
NPI:1023268687
Name:MALLAY, RUBAIYA (DO)
Entity type:Individual
Prefix:DR
First Name:RUBAIYA
Middle Name:
Last Name:MALLAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:RUBAIYA
Other - Middle Name:
Other - Last Name:TALUKDAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:13644 WALSINGHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774
Mailing Address - Country:US
Mailing Address - Phone:727-595-2519
Mailing Address - Fax:727-595-3872
Practice Address - Street 1:13644 WALSINGHAM ROAD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774
Practice Address - Country:US
Practice Address - Phone:727-595-2519
Practice Address - Fax:727-595-3872
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10496207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006502500Medicaid
4039402OtherMAIL HANDLERS BENEFIT PLAN (MHBP)
FL591273247OtherTRICARE STANDARD
FL362294OtherAVMED
FL2447922OtherFIRST HEALTH AND COVENTRY NATIONAL NETWORK
FL14A3EOtherBCBS BLUE OPTIONS, BLUE CHOICE, FEDERAL BLUE, FLORIDA STATE, TRADITIONAL BCBS
FL59127324OtherUHC EMPIRE PLAN
FL14A3EOtherBCBS BLUE CARE, ADVANTAGE 65 SELECT, MEDICARE PPO/HMO, GO BLUE
FL9521897OtherAETNA, PPO, HMO, EPO, MANAGED CHOICE, MEDICARE HMO/PPO
FL14A3EOtherOUT OF STATE BLUE CROSS BLUE SHIELD
FL6913529OtherCIGNA PPO/HMO, OPEN ACCESS AND GREATWEST
FL362294OtherAVMED
FLGE125YMedicare PIN