Healthcare Provider Details

I. General information

NPI: 1043655434
Provider Name (Legal Business Name): CHARLES BRANDON MALOY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 STUYVESANT RD
ASHEVILLE NC
28803-3150
US

IV. Provider business mailing address

581 LEROY GEORGE DR STE 300
CLYDE NC
28721-8085
US

V. Phone/Fax

Practice location:
  • Phone: 828-707-2015
  • Fax:
Mailing address:
  • Phone: 828-452-4131
  • Fax: 828-452-4095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2019-02195
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: