Provider Demographics
NPI:1700879640
Name:MALAKAR, JAGADISH C (MD)
Entity Type:Individual
Prefix:
First Name:JAGADISH
Middle Name:C
Last Name:MALAKAR
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 1:129 HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1230
Mailing Address - Country:US
Mailing Address - Phone:607-753-3355
Mailing Address - Fax:607-753-8724
Practice Address - Street 1:129 HOMER AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1230
Practice Address - Country:US
Practice Address - Phone:607-753-3355
Practice Address - Fax:607-753-8724
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247103-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY247103-1OtherLICENSE #
NY01950467Medicaid
NYCC8630Medicare ID - Type Unspecified
NY247103-1OtherLICENSE #