Healthcare Provider Details

I. General information

NPI: 1588649834
Provider Name (Legal Business Name): DEBRA L MALONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

22 PEPPERDINE CIR
CATONSVILLE MD
21228-5382
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7233
  • Fax: 410-605-7919
Mailing address:
  • Phone: 410-788-1686
  • Fax: 410-605-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0056343
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: