Provider Demographics
NPI:1710309919
Name:MALONEY, PATRICK TIMOTHY JR
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:TIMOTHY
Last Name:MALONEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1551
Mailing Address - Country:US
Mailing Address - Phone:850-503-6274
Mailing Address - Fax:
Practice Address - Street 1:793 W STATE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1551
Practice Address - Country:US
Practice Address - Phone:850-503-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9278575367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered