Provider Demographics
NPI:1851808356
Name:ALYSON MALOY MD PC
Entity Type:Organization
Organization Name:ALYSON MALOY MD PC
Other - Org Name:PORTLAND COGNITIVE AND BEHAVIORAL NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-222-3021
Mailing Address - Street 1:449 FOREST AVE # 214
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2029
Mailing Address - Country:US
Mailing Address - Phone:207-222-3021
Mailing Address - Fax:
Practice Address - Street 1:449 FOREST AVE # 214
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2029
Practice Address - Country:US
Practice Address - Phone:207-222-3021
Practice Address - Fax:207-536-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD191472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty