Provider Demographics
NPI:1356377204
Name:MALONE, STEPHEN L (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:MALONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 BEISER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7790
Mailing Address - Country:US
Mailing Address - Phone:302-734-9700
Mailing Address - Fax:302-734-9702
Practice Address - Street 1:260 BEISER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7790
Practice Address - Country:US
Practice Address - Phone:302-734-9700
Practice Address - Fax:302-734-9702
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008853207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2111951Medicaid
MAH51965OtherINDIVIDUAL
MAA39519Medicare ID - Type UnspecifiedINDIVIDUAL