Provider Demographics
NPI: | 1508982125 |
---|---|
Name: | MALONEY, MATTHEW T (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MATTHEW |
Middle Name: | T |
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: | 8000 E MAPLEWOOD AVE STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | GREENWOOD VILLAGE |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80111-4727 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-438-3999 |
Mailing Address - Fax: | 720-439-9500 |
Practice Address - Street 1: | 8000 E MAPLEWOOD AVE STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | GREENWOOD VILLAGE |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80111-4727 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-438-3999 |
Practice Address - Fax: | 720-439-9500 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-03-22 |
Last Update Date: | 2020-01-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 43277 | 207L00000X, 207L00000X |
IA | 33146 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 20052286 | Medicaid | |
016471 | Other | KAISER-COMMERCIAL NUMBER | |
016471 | Other | KAISER-COMMERCIAL NUMBER | |
CO | G83459 | Medicare UPIN |