Provider Demographics
NPI:1407349087
Name:MALLOY, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MALLOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 MIDTOWN SQ APT 2020
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4421
Mailing Address - Country:US
Mailing Address - Phone:240-354-8955
Mailing Address - Fax:
Practice Address - Street 1:1311 ANACOSTIA RD SE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2100
Practice Address - Country:US
Practice Address - Phone:240-354-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant