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NPI Code Detail

MEDICARE: DR. KELLY ELIZABETH MALONEY M.D.

MEDICARE: DR. KELLY ELIZABETH MALONEY M.D.
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
1208800000XUrology Physician31659SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356431589
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY ELIZABETH MALONEY M.D.
Provider Business Mailing Address
First Line : 540 PHYSICIANS LN
Second Line :
City : SUMTER
State : SC
Zip : 29150-3370
Country : US
Telephone Number : 803-340-5100
Fax Number : 803-848-8134
Provider Business Practice Location Address
First Line : 222 E MEDICAL LN STE 101
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29169-4850
Country : US
Telephone Number : 803-739-3660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 03/15/2021

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