Provider Demographics
NPI:1275533887
Name:MALONEY, THOMAS OWEN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:OWEN
Last Name:MALONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LYNCH CREEK WAY
Mailing Address - Street 2:#5
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2357
Mailing Address - Country:US
Mailing Address - Phone:707-763-6585
Mailing Address - Fax:707-763-2788
Practice Address - Street 1:108 LYNCH CREEK WAY
Practice Address - Street 2:#5
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2357
Practice Address - Country:US
Practice Address - Phone:707-763-6585
Practice Address - Fax:707-763-2788
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C276200Medicaid
A33421Medicare UPIN
CA00C276200Medicaid