Provider Demographics
NPI:1225144629
Name:MALONEY, MARY M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:MALONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2821 EMERALD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2403
Mailing Address - Country:US
Mailing Address - Phone:260-490-8110
Mailing Address - Fax:260-490-7707
Practice Address - Street 1:310 E DUPONT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2048
Practice Address - Country:US
Practice Address - Phone:260-490-8110
Practice Address - Fax:260-490-7707
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01032404A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND67868Medicare UPIN
IN176530BMedicare ID - Type Unspecified