Provider Demographics
NPI:1831396100
Name:MALBIN, ANDREW SAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SAUL
Last Name:MALBIN
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 320506
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-2506
Mailing Address - Country:US
Mailing Address - Phone:813-254-7878
Mailing Address - Fax:813-254-8488
Practice Address - Street 1:2820 W MORRISON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5335
Practice Address - Country:US
Practice Address - Phone:813-254-7878
Practice Address - Fax:813-254-8488
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35504207P00000X
NY147633-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21370Medicare UPIN
FL15577Medicare ID - Type UnspecifiedMEDICARE