Basic Information
| Provider Information | |||||||||
| NPI: | 1982649802 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALBERT K MALL MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 FRANKLIN ST | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142627980 | ||||||||
| FaxNumber: | 8142627983 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 FRANKLIN ST | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142627980 | ||||||||
| FaxNumber: | 8142627983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 05/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | MALL | ||||||||
| AuthorizedOfficialFirstName: | ALBERT | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER MD | ||||||||
| AuthorizedOfficialTelephone: | 8142627980 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD023412E | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1015110720001 | 05 | PA | MEDICAID | 1772345 | 01 | PA | BCBS | OTHER | DE7604 | 01 | PA | RAILROAD MEDICARE | OTHER |