Provider Demographics
NPI:1134176845
Name:MALUMED, JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:MALUMED
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 1:1 BARTOL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2214
Mailing Address - Country:US
Mailing Address - Phone:610-521-8970
Mailing Address - Fax:610-521-3983
Practice Address - Street 1:1 BARTOL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2214
Practice Address - Country:US
Practice Address - Phone:610-521-8970
Practice Address - Fax:610-521-3983
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043733E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011677160001Medicaid
PA403872NU9Medicare ID - Type Unspecified
PA0011677160001Medicaid