Provider Demographics
NPI:1700075736
Name:TIMOTHY D. MALONE MD
Entity Type:Organization
Organization Name:TIMOTHY D. MALONE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-779-7500
Mailing Address - Street 1:1415 BLANDING ST
Mailing Address - Street 2:STE 4
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2922
Mailing Address - Country:US
Mailing Address - Phone:803-779-7500
Mailing Address - Fax:803-779-7522
Practice Address - Street 1:1415 BLANDING ST
Practice Address - Street 2:STE 4
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2922
Practice Address - Country:US
Practice Address - Phone:803-779-7500
Practice Address - Fax:803-779-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC173555Medicaid
SC582296052OtherPBMC BEHAVIORAL HEALTH
SC173555Medicaid