Provider Demographics
NPI:1700037009
Name:CYRUS J. MALI, M.D., INC.
Entity Type:Organization
Organization Name:CYRUS J. MALI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-342-2890
Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1223
Mailing Address - Country:US
Mailing Address - Phone:304-342-0703
Mailing Address - Fax:304-342-2890
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 500
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-342-0703
Practice Address - Fax:304-342-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107542088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0130951000Medicaid
D49328Medicare UPIN