Provider Demographics
NPI:1437135183
Name:MALONE, RICKY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:
Last Name:MALONE
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 1:15000 POTOMAC TOWN PL STE 100-234
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6586
Mailing Address - Country:US
Mailing Address - Phone:571-766-6520
Mailing Address - Fax:
Practice Address - Street 1:6900 GEORGIA AVE NW
Practice Address - Street 2:WASHINGTON
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-5001
Practice Address - Country:US
Practice Address - Phone:202-782-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH05952083A0100X, 2084P0800X
VA01012595682083X0100X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry