=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942447339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE ORTHOPAEDIC SPINE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2009
-----------------------------------------------------
Last Update Date | 01/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 BEISER BLVD SUITE 101
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19904-7790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-829-2606
-----------------------------------------------------
Fax | 401-245-4812
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 BEISER BLVD SUITE 101
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19904-7790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-829-2606
-----------------------------------------------------
Fax | 401-245-4812
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | STEPHEN L. MALONE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 401-829-2606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0117X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery of the Spine Physician
-----------------------------------------------------
License Number | C1-0008852
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------