Provider Demographics
NPI:1346487709
Name:MALONEY, MAJA (PA-C)
Entity Type:Individual
Prefix:
First Name:MAJA
Middle Name:
Last Name:MALONEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37399 GARFIELD RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3672
Mailing Address - Country:US
Mailing Address - Phone:586-286-5400
Mailing Address - Fax:586-263-4831
Practice Address - Street 1:37399 GARFIELD RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3672
Practice Address - Country:US
Practice Address - Phone:586-286-5400
Practice Address - Fax:586-263-4831
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1346487709Medicaid