Provider Demographics
NPI:1871570572
Name:OWENS, MALCOLM CHRISTOPHER JR (PA)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:CHRISTOPHER
Last Name:OWENS
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MAGNOLIA MEADOWS PKWY
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:DE
Mailing Address - Zip Code:19962-9347
Mailing Address - Country:US
Mailing Address - Phone:302-335-1551
Mailing Address - Fax:
Practice Address - Street 1:1275 SOUTH STATE STREET
Practice Address - Street 2:
Practice Address - City:DOVER AFB
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-678-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041602363AM0700X
DEC5-0000519207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE138171Y0DMedicare PIN