Basic Information
| Provider Information | |||||||||
| NPI: | 1356395792 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALDEN | ||||||||
| FirstName: | ERIC | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7209874446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 38361 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 25094 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-36274 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD17554 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 11451581 | 05 | NM | MEDICAID | 200025620A | 05 | OK | MEDICAID | 97624349 | 05 | CO | MEDICAID | CO306497 | 01 | CO | MCR TB MIC | OTHER | Q38361 | 05 | SC | MEDICAID | 1356395792 | 05 | MT | MEDICAID | 200254280A | 05 | KS | MEDICAID | 300111551 | 01 | CO | RR MIC MEDICARE | OTHER | 373313 | 05 | AZ | MEDICAID | 104686267 | 05 | MI | MEDICAID | 84-059792913 | 05 | NE | MEDICAID | NA1214044 | 01 | NE | WPS MCR NE | OTHER | 1356395792 | 05 | WY | MEDICAID | 1356395792 | 05 | SD | MEDICAID | 300111554 | 01 | CO | RR RIA MEDICARE | OTHER | 10025709000 | 05 | NE | MEDICAID | 1356395792 | 05 | IA | MEDICAID | NA1215044 | 01 | NE | WPS MCR NE | OTHER |