Healthcare Provider Details

I. General information

NPI: 1326047804
Provider Name (Legal Business Name): JOSEPH PATRICK MALONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 WYOMING ST
DAYTON OH
45409-2731
US

IV. Provider business mailing address

122 WYOMING ST
DAYTON OH
45409-2731
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-4461
  • Fax: 937-224-1945
Mailing address:
  • Phone: 937-223-4461
  • Fax: 937-224-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35039595
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: