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General NPI Number Information
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NPI Number | 1083783245
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Entity Type | Individual
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Provider Name | STEPHEN JAMES MALLONEY D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 134 MEDICAL PARK RD STE 100
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City | MOORESVILLE
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State | NC
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Zip | 28117-8527
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Country | US
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Telephone | 704-662-0106
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Fax | 808-290-6369
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Provider Business Mailing Address
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Address Line | PO BOX 1845
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City | STATESVILLE
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State | NC
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Zip | 28687-1845
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 990
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2015-01843
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License Number State | NC
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