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General NPI Number Information
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NPI Number | 1306825609
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Entity Type | Individual
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Provider Name | ANDREA MARIE MALON M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 540 SAYBROOK RD STE 100
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4760
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Country | US
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Telephone | 860-358-2850
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Fax | 860-358-8698
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Provider Business Mailing Address
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Address Line | 862 ARBUTUS ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-5177
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Country | US
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Telephone | 860-346-2608
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 033184
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 033184
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 21347
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 033184
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License Number State | CT
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