Provider Demographics
NPI:1831120534
Name:MAALOUF, TONY MAURICE (MD)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:MAURICE
Last Name:MAALOUF
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 1:407 W JEFFERSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5485
Mailing Address - Country:US
Mailing Address - Phone:724-283-1005
Mailing Address - Fax:724-283-4612
Practice Address - Street 1:407 W JEFFERSON ST STE B
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5485
Practice Address - Country:US
Practice Address - Phone:724-283-1005
Practice Address - Fax:724-283-4612
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054326L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015480890002Medicaid
PA0015480890002Medicaid
PA065142Medicare ID - Type Unspecified