Provider Demographics
NPI:1871512269
Name:MALONE, AMANDA K (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:K
Last Name:MALONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:25500 DEFENSE HIGHWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114
Mailing Address - Country:US
Mailing Address - Phone:301-373-7900
Mailing Address - Fax:301-373-6900
Practice Address - Street 1:25500 DEFENSE HIGHWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114
Practice Address - Country:US
Practice Address - Phone:301-373-7900
Practice Address - Fax:301-373-6900
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8155882OtherMAMSI PRIMARY CARE
MD2155882OtherMAMSI SPECIALIST
MD1385582OtherCIGNA PIN
MDP00337274OtherRAILROAD MEDICARE
MDP17244OtherMD POS
MD1410470OtherAETNA FEE FOR SERVICE
MD410680600Medicaid
MD7155663OtherAETNA CAPITATED
MD7605-0085OtherCAREFIRST BLUECHOICE
MD890348-01OtherCAREFIRST MD RENDERING
MD203917OtherJHHC PROVIDER NUMBER
MD8155882OtherMAMSI PRIMARY CARE
MD7155663OtherAETNA CAPITATED