Provider Demographics
NPI:1912909854
Name:MALOLA, MERLYN (MD)
Entity Type:Individual
Prefix:MRS
First Name:MERLYN
Middle Name:
Last Name:MALOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N STATE ROAD 25
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-9785
Mailing Address - Country:US
Mailing Address - Phone:574-223-2020
Mailing Address - Fax:574-223-5847
Practice Address - Street 1:710 N STATE ROAD 25
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-9785
Practice Address - Country:US
Practice Address - Phone:574-223-2020
Practice Address - Fax:574-223-5847
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042889A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F95918Medicare UPIN
IN270990KMedicare ID - Type Unspecified