Healthcare Provider Details

I. General information

NPI: 1851808356
Provider Name (Legal Business Name): ALYSON MALOY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 11/25/2024
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 TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD19147
License Number StateME

VIII. Authorized Official

Name: DR. ALYSON E. MALOY
Title or Position: PRESIDENT
Credential: MD
Phone: 207-222-3021