Provider Demographics
NPI:1598737090
Name:O'MALLEY, DONALD EDMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EDMOND
Last Name:O'MALLEY
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:PO BOX 765
Mailing Address - Street 2:360 GIFFORD ST UNIT 2B
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02541-0765
Mailing Address - Country:US
Mailing Address - Phone:508-540-0200
Mailing Address - Fax:508-540-1677
Practice Address - Street 1:360 GIFFORD ST
Practice Address - Street 2:UNIT 2B
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2912
Practice Address - Country:US
Practice Address - Phone:508-540-0200
Practice Address - Fax:508-540-1677
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8429172001OtherCIGNA
MA202895805OtherAETNA
MA240681OtherHARVARD PILGRIM
MA157476OtherTUFTS
MA202895805OtherHEALTH CARE VALUE MANAGEM
MAJ18951OtherBLUE CROSS BLUE SHIELD
MA202895805OtherAETNA
MA8429172001OtherCIGNA