Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MD465170 | PA |
N | 2081S0010X | Sports Medicine | MD465170 | PA |
N | 213ES0000X | Sports Medicine | MD465170 | PA |
NPI | 1023438041 |
---|---|
Provider Name | Michael Maloney |
First Address | Philadelphia, PA 19104-5548 |
Second Address | Philadelphia, PA 19104-5548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2014 |
Last Update Date | 09/03/2020 |