Healthcare Provider Details

I. General information

NPI: 1124429261
Provider Name (Legal Business Name): MEGAN KATHLEEN MALONEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 CALIFORNIA RD STE A
ELKHART IN
46514-1228
US

IV. Provider business mailing address

2310 CALIFORNIA RD STE A
ELKHART IN
46514-1228
US

V. Phone/Fax

Practice location:
  • Phone: 574-264-0791
  • Fax:
Mailing address:
  • Phone: 574-264-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10001709A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: