Provider Demographics
NPI:1063815173
Name:MALONEY, MARVELLE TEKOLA (MD)
Entity Type:Individual
Prefix:
First Name:MARVELLE
Middle Name:TEKOLA
Last Name:MALONEY
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 1:100 SAN PABLO TOWNE CENTER A STE 100
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806
Mailing Address - Country:US
Mailing Address - Phone:510-724-9110
Mailing Address - Fax:
Practice Address - Street 1:100 SAN PABLO TOWNE CENTER A STE 100
Practice Address - Street 2:STE 100
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806
Practice Address - Country:US
Practice Address - Phone:510-724-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10395200207V00000X
CAA177821207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology