MEDICARE: DR. TANYA DENICE MALONE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS010061L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124136007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANYA DENICE MALONE D.O.

Provider Business Mailing Address
First Line	:	1429 E JOHNSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1107
Country	:	US
Telephone Number	:	215-407-8208
Fax Number	:	215-685-2440

Provider Business Practice Location Address
First Line	:	2840 W DAUPHIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-4627
Country	:	US
Telephone Number	:	215-685-2403
Fax Number	:	215-685-2440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	06/08/2012

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Directions to “ DR. TANYA DENICE MALONE D.O.” Practice Location

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