Basic Information
| Provider Information | |||||||||
| NPI: | 1285602771 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALAQUIAS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 COMMUNICATIONS WAY | ||||||||
| Address2: | MACC - REVENUE CYCLE | ||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026011866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089578664 | ||||||||
| FaxNumber: | 5089578677 | ||||||||
| Practice Location | |||||||||
| Address1: | 257 STATION AVENUE | ||||||||
| Address2: | |||||||||
| City: | SOUTH YARMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083948303 | ||||||||
| FaxNumber: | 5083986680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 05/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 40224 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2061619 | 05 | MA | MEDICAID | 6832 | 01 | MA | HPHC | OTHER | L15111 | 01 | MA | BCBS | OTHER |