Provider Demographics
NPI:1881951929
Name:MALIA, LAURIE (DO)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:MALIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:282 WASHINGTON STREET
Mailing Address - Street 2:MEDICAL EDUCATION, 4H
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-545-9973
Mailing Address - Fax:860-545-9973
Practice Address - Street 1:282 WASHINGTON STREET
Practice Address - Street 2:MEDICAL EDUCATION, 4H
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-545-9973
Practice Address - Fax:860-545-9973
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT111508812080P0204X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program