Provider Demographics
NPI:1578529087
Name:KEVIN MALONE DO PC
Entity Type:Organization
Organization Name:KEVIN MALONE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-275-9650
Mailing Address - Street 1:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-4200
Mailing Address - Country:US
Mailing Address - Phone:603-673-9411
Mailing Address - Fax:603-673-9899
Practice Address - Street 1:10 RESEARCH PL
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2439
Practice Address - Country:US
Practice Address - Phone:978-275-9650
Practice Address - Fax:978-275-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM19080OtherBLUE CROSS BLUE SHIELD
MA0036244OtherNEIGHBORHOOD HEALTH
MA9741411Medicaid
MA0036244OtherNEIGHBORHOOD HEALTH
MAM19080OtherBLUE CROSS BLUE SHIELD