Provider Demographics
NPI:1861420911
Name:MALFETANO, JOHN H (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:MALFETANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:24 COMPUTER DR W
Mailing Address - Street 2:STE 100
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1612
Mailing Address - Country:US
Mailing Address - Phone:518-689-7548
Mailing Address - Fax:518-489-7548
Practice Address - Street 1:24 COMPUTER DR W
Practice Address - Street 2:STE 100
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1612
Practice Address - Country:US
Practice Address - Phone:518-689-7548
Practice Address - Fax:518-489-7548
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY154115207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00775333Medicaid
NY10005938OtherCDPHP
NY141811164OtherBLUE SHIELD NENY
NY69150OtherMVP
NY110038OtherWELLCARE
NY69150OtherMVP
NY110038OtherWELLCARE