Healthcare Provider Details

I. General information

NPI: 1720344245
Provider Name (Legal Business Name): CHANDRA CAMPBELL MALONEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 QUEEN ANNE AVE N
SEATTLE WA
98109-2367
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-861-8500
  • Fax: 206-861-8501
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60487163
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: