Provider Demographics
NPI:1043395650
Name:MALONE, MEGHAN LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LYNNE
Last Name:MALONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2180
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-2180
Mailing Address - Country:US
Mailing Address - Phone:843-347-6038
Mailing Address - Fax:843-234-6990
Practice Address - Street 1:2376 CYPRESS CIRCLE
Practice Address - Street 2:SUITE 203
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8994
Practice Address - Country:US
Practice Address - Phone:843-347-6038
Practice Address - Fax:843-347-9808
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL27196207R00000X
SC27196207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC271967Medicaid
SCAA5620Medicare UPIN