Individual provider Active NPI

Timothy C Malyk, M.D.

  • Family Medicine Physician
  • Skowhegan, ME
National Provider Identifier
1225035512
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD16709 Issued in ME
Practice address
46 Fairview Ave Ste 111
Skowhegan, ME 04976-1481
Phone
(207) 474-3320
Fax
(207) 474-5067
NPI assigned
Jul 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD16709 ME Primary

Addresses

Primary practice location

46 Fairview Ave Ste 111
Skowhegan, ME 04976-1481

Mailing address

PO Box 468
Skowhegan, ME 04976-0468
Phone (207) 858-8367

Other identifiers 1

IdentifierTypeStateIssuer
1225035512MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041201000256 ME Practitioner - Family Practice 8527021716 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD16709MEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Redington-Fairview General Hospital Family Medicine CurrentSince Jul 6, 2009 Accepting new patients
Redington-Fairview General Hospital CurrentSince Jul 6, 2009 Accepting new patients

Locations

46 Fairview Ave
Ste 111
Skowhegan, ME 04976
Phone (207) 474-3320

46 Fairview Ave
Ste 111B
Skowhegan, ME 04976

46 Fairview Ave
Skowhegan, ME 04976
Phone 2074745121293

Interoperability endpoints

  • Direct secure messaging: timothy.malyk@rfp.direct.rfgh.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1225035512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 468",
            "city": "SKOWHEGAN",
            "state": "ME",
            "postal_code": "049760468",
            "telephone_number": "207-858-8367",
            "fax_number": "207-474-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 FAIRVIEW AVE STE 111",
            "city": "SKOWHEGAN",
            "state": "ME",
            "postal_code": "049761481",
            "telephone_number": "207-474-3320",
            "fax_number": "207-474-5067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALYK",
        "first_name": "TIMOTHY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "MD16709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225035512",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Skowhegan, ME

Sources for this page

Verify at the official NPI Registry.