Provider Demographics
NPI:1144282815
Name:KING, MALCOLM H (MDPSC)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:H
Last Name:KING
Suffix:
Gender:M
Credentials:MDPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 LEXINGTON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2873
Mailing Address - Country:US
Mailing Address - Phone:606-325-9633
Mailing Address - Fax:606-325-9634
Practice Address - Street 1:2301 LEXINGTON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2873
Practice Address - Country:US
Practice Address - Phone:606-325-9633
Practice Address - Fax:606-325-9634
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12569207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK001463OtherCHAMPUS
KY000000045301OtherANTHEM/BLUE CROSS/BLUE SH
KY64125693Medicaid
KYC68076Medicare UPIN
KY64125693Medicaid