Provider Demographics
NPI:1447312020
Name:MALAMUT, RICHARD I (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:I
Last Name:MALAMUT
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 1:18 S LONGPOINT LN
Mailing Address - Street 2:
Mailing Address - City:ROSE VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4948
Mailing Address - Country:US
Mailing Address - Phone:610-589-1129
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE ACP #533
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-874-1184
Practice Address - Fax:610-874-4258
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036449E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE55594Medicare UPIN
PA608736Medicare ID - Type Unspecified