Basic Information
| Provider Information | |||||||||
| NPI: | 1578529087 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEVIN MALONE DO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2200 | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030314200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036739411 | ||||||||
| FaxNumber: | 6036739899 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 RESEARCH PL | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | NORTH CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018632439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782759650 | ||||||||
| FaxNumber: | 9782759566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 10/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | MALONE | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9782759650 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | M19080 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 0036244 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 9741411 | 05 | MA | MEDICAID |