Provider Demographics
NPI:1053381210
Name:MALOUF, GEORGE S JR (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:MALOUF
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 TELFAIR BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-5217
Mailing Address - Country:US
Mailing Address - Phone:301-423-5252
Mailing Address - Fax:
Practice Address - Street 1:4400 TELFAIR BLVD STE D
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-5217
Practice Address - Country:US
Practice Address - Phone:301-423-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024043207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0465204OtherAETNA
MD22940001OtherBC/BS
MH25223OtherMDIPA/OPTIMUM CHOICE
MD0465204OtherAETNA
DC512520Medicare PIN
MDB92748Medicare UPIN