Provider Demographics
NPI:1649272303
Name:LOUDEN, MALCOLM BARRY (MD)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:BARRY
Last Name:LOUDEN
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:PO BOX 4179
Mailing Address - Street 2:
Mailing Address - City:PARKESBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-4179
Mailing Address - Country:US
Mailing Address - Phone:304-485-5041
Mailing Address - Fax:304-485-5678
Practice Address - Street 1:3803 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1116
Practice Address - Country:US
Practice Address - Phone:304-485-5041
Practice Address - Fax:304-485-5678
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045546207R00000X
OH455462084N0400X, 2084S0012X
WV111732084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0432428Medicaid
WV0091000000Medicaid
OH0474946Medicare PIN
OHA72068Medicare UPIN
WV0091000000Medicaid
WV0474943Medicare PIN
WV0474942Medicare PIN