Provider Demographics
NPI:1407845332
Name:MALANE, MICHELLE S (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:MALANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1781 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1254
Mailing Address - Country:US
Mailing Address - Phone:203-272-3376
Mailing Address - Fax:203-272-9539
Practice Address - Street 1:1781 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1254
Practice Address - Country:US
Practice Address - Phone:203-272-3376
Practice Address - Fax:203-272-9539
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034944207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG38502Medicare UPIN
D400024926Medicare PIN