Provider Demographics
NPI:1265421523
Name:MALKIN, GERALD OSCAR (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:OSCAR
Last Name:MALKIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OLDE LANTERN RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2011
Mailing Address - Country:US
Mailing Address - Phone:978-263-3467
Mailing Address - Fax:
Practice Address - Street 1:133 OLD ROAD TO 9 ACRE COR
Practice Address - Street 2:EMERSON HOSPITAL DEPARTMENT OF ANESTHESIA
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4159
Practice Address - Country:US
Practice Address - Phone:978-287-3162
Practice Address - Fax:978-287-3508
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12001207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
X20016Medicare ID - Type Unspecified
U33298Medicare UPIN