Provider Demographics
NPI:1982610663
Name:MALONEY, MARK W (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:MALONEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0447
Mailing Address - Country:US
Mailing Address - Phone:814-375-3913
Mailing Address - Fax:814-375-5258
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-375-3913
Practice Address - Fax:814-375-5258
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009147-L207Q00000X
PAOS009147L208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016968780003Medicaid
PA000976061OtherBLUE CROSS
PA015472Medicare ID - Type Unspecified
PAG78263Medicare UPIN