Provider Demographics
NPI:1598187650
Name:MALONE, ROBERTA S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:S
Last Name:MALONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 BROWNS CT SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1231
Mailing Address - Country:US
Mailing Address - Phone:202-393-1967
Mailing Address - Fax:
Practice Address - Street 1:8700 CENTRAL AVE
Practice Address - Street 2:205
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4831
Practice Address - Country:US
Practice Address - Phone:240-619-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD21207208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice