Healthcare Provider Details

I. General information

NPI: 1083800106
Provider Name (Legal Business Name): ALYSON MALOY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 WASHINGTON AVE
PORTLAND ME
04103-4928
US

IV. Provider business mailing address

735 WASHINGTON AVE
PORTLAND ME
04103-4928
US

V. Phone/Fax

Practice location:
  • Phone: 207-222-3021
  • Fax: 207-536-0334
Mailing address:
  • Phone: 207-222-3021
  • Fax: 207-536-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number240082
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number240082
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberMD19147
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: