Provider Demographics
NPI:1356543821
Name:DOROTHY MALONE-RISING, N.P., P.C.
Entity type:Organization
Organization Name:DOROTHY MALONE-RISING, N.P., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE-RISING
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:802-635-6689
Mailing Address - Street 1:384 LOWER MAIN W
Mailing Address - Street 2:PO BOX 318
Mailing Address - City:JOHNSON
Mailing Address - State:VT
Mailing Address - Zip Code:05656-9632
Mailing Address - Country:US
Mailing Address - Phone:802-635-6689
Mailing Address - Fax:802-635-7435
Practice Address - Street 1:384 LOWER MAIN W
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:VT
Practice Address - Zip Code:05656-9632
Practice Address - Country:US
Practice Address - Phone:802-635-6689
Practice Address - Fax:802-635-7435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010013373261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTONP0734Medicaid