1265459754 NPI number — JOHN R MALONEY MD

Table of content: JOHN R MALONEY MD (NPI 1265459754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265459754 NPI number — JOHN R MALONEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALONEY
Provider First Name:
JOHN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265459754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20861-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-570-9700
Provider Business Mailing Address Fax Number:
301-260-2838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2141 K ST NW
Provider Second Line Business Practice Location Address:
STE 304
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20037-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-496-9700
Provider Business Practice Location Address Fax Number:
202-496-9777
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  8041 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0071-7327-0 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: C62372 . This is a "UPIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5663JR . This is a "CAREFIRST MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 8101 . This is a "CAREFIRST DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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