Provider Demographics
NPI:1780682195
Name:MALANEY, KATHLEEN RUTH (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RUTH
Last Name:MALANEY
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 1:6 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:ISLE OF PALMS
Mailing Address - State:SC
Mailing Address - Zip Code:29451-2604
Mailing Address - Country:US
Mailing Address - Phone:843-886-4974
Mailing Address - Fax:843-886-4430
Practice Address - Street 1:1202 PALM BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ISLE OF PALMS
Practice Address - State:SC
Practice Address - Zip Code:29451-2296
Practice Address - Country:US
Practice Address - Phone:843-886-4402
Practice Address - Fax:843-886-4430
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC131146Medicaid
SCD17522Medicare UPIN
SC7341Medicare ID - Type UnspecifiedMEDICAL PROVIDER