Provider Demographics
NPI:1770545469
Name:KING, MALCOLM A (MDPSC)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:A
Last Name:KING
Suffix:
Gender:M
Credentials:MDPSC
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 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-324-4745
Mailing Address - Fax:606-324-4941
Practice Address - Street 1:613 23RD ST
Practice Address - Street 2:SUITE 230
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2878
Practice Address - Country:US
Practice Address - Phone:606-324-4745
Practice Address - Fax:606-324-4941
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24195207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0085561000Medicaid
KY110028144OtherTRAVELERS MEDICARE
KY64241953Medicaid
KY000000049114OtherANTHEM/BLUE CROSS/BLUE SH
KY611140483OtherCOMMERCIAL
KYK011087OtherCHAMPUS
OH0690542Medicaid
KY00788034Medicare PIN
OH0690542Medicaid
KYK011087OtherCHAMPUS