Provider Demographics
NPI:1588629679
Name:MALONEY, MARTIN JUDE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JUDE
Last Name:MALONEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:567 VAUXHALL STREET EXT STE 118
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4332
Mailing Address - Country:US
Mailing Address - Phone:860-444-0503
Mailing Address - Fax:860-444-0504
Practice Address - Street 1:77 E TOWN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2338
Practice Address - Country:US
Practice Address - Phone:860-822-4752
Practice Address - Fax:860-892-7043
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT 0001592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008031142Medicaid
B38210Medicare UPIN