Lucy B Malkasian, MD
Individual provider Active NPI Pediatrics Physician · Wahpeton, ND
NPI 1215972773 · NPPES record last updated Sep 20, 2011
Key facts
- NPI
- 1215972773
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 4761 (ND)
- Practice address
- 275 11TH St S
Wahpeton, ND 58075-4655 - Phone
- (701) 642-2000
- Fax
- (701) 671-4106
- NPI assigned
- Jun 18, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4761 | ND | MD | Social Worker |
| 27260 | MN | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4761 | ND | Yes |
| Pediatrics Physician | 208000000X | 27260 | MN |
Addresses
Primary practice location
275 11TH St S
Wahpeton, ND 58075-4655
Mailing address
275 11TH St S
Wahpeton, ND 58075-4655
Phone (701) 642-2000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 142036 | Other | ND | UCARE # |
| 7775590 | Medicaid | ND | |
| DA9051015636 | Other | ND | PREFERRED ONE # |
| HP19525 | Other | ND | HEALTHPARTNERS # |
| 30657 | Other | ND | SIOUX VALLEY # |
| 103062100 | Medicaid | ND | |
| 2495 | Other | ND | NDBS # |
| 2724 | Other | ND | NDBS # |
| ND100017 | Other | ND | LHS # |
| 1201182 | Other | ND | MEDICA # |
| 14103 | Medicaid | ND | |
| 676668 | Other | ND | AMERICA'S PPO/ARAZ # |
| 93114MA | Other | ND | MNBS # |
Other names
- Lucy B Mesrobian
Other providers in Wahpeton, ND
- Alezay Jazelle Rose Luna
- Alicia Luna
- Arturo Luna Jr.
- Michaela Amorita Luna
- Rosanne Lysne
- Trisha Martin
- Ruby A Martinez
- Niklaas Mattson
- William M Mayo
- Paula L McDonald
All providers in Wahpeton, ND · Pediatrics Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.