Basic Information
| Provider Information | |||||||||
| NPI: | 1730180027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALARO | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | DECKER | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DECKER | ||||||||
| OtherFirstName: | MARGARET | ||||||||
| OtherMiddleName: | CAUTHORN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 12622 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816572 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 COURSEVALL DR | ||||||||
| Address2: | |||||||||
| City: | CENTREVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216172804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107583303 | ||||||||
| FaxNumber: | 4107583310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 11/29/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0055127 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9118749 | 01 | MD | CIGNA PIN | OTHER | P16282 | 01 | MD | CAREFIRST MPOS | OTHER | 028274 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | 355703100 | 05 | MD | MEDICAID | 83108504 | 01 | BCBS MD | OTHER | P8650002 | 01 | BCBS DC | OTHER | 8145086 | 01 | MD | MAMSI PRIMARY CARE | OTHER | 831085-03 | 01 | MD | CAREFIRST MD RENDERING | OTHER | P00208139 | 01 | MD | RR MEDICARE | OTHER | 7605-0065 | 01 | MD | CAREFIRST BLUECHOICE | OTHER | P18698 | 01 | BCBS POS | OTHER | 2145086 | 01 | MD | MAMSI SPECIALIST | OTHER | 3481753 | 01 | MD | AETNA CAPITATED | OTHER | 5965386 | 01 | MD | AETNA FEE FOR SERVICE | OTHER |