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Organization

BLACKWATER MEDICAL ASSOCIATES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARK M MALKUS M.D. (PRESIDENT)
(410) 228-1068
Entity
Organization

Contact information

Practice address
408 BYRN ST, CAMBRIDGE, MD 21613-1910
(410) 228-1068
Mailing address
408 BYRN ST, CAMBRIDGE, MD 21613-1910
(410) 228-1068

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0050804
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7810000800
MD
Enumeration date
03/30/2007
Last updated
08/22/2020
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