Provider Demographics
NPI:1821224361
Name:MALLOY, MEGHAN COLLEEN (PA)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:COLLEEN
Last Name:MALLOY
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:MAP 2 SUITE 3302
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-623-4004
Mailing Address - Fax:302-623-4289
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:MAP 2 SUITE 3302
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2072
Practice Address - Country:US
Practice Address - Phone:302-623-4004
Practice Address - Fax:302-623-4289
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2017-04-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE157872ZAEJMedicare UPIN