Provider Demographics
NPI:1285691204
Name:MALONE, KEVIN (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MALONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-4200
Mailing Address - Country:US
Mailing Address - Phone:603-673-9411
Mailing Address - Fax:603-673-9899
Practice Address - Street 1:10 RESEARCH PL
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2439
Practice Address - Country:US
Practice Address - Phone:978-275-9650
Practice Address - Fax:978-275-9566
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA214167207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0034207OtherNEIGHBORHOOD HEALTH
MA97185301OtherNETWORK HEALTH
MAJ25407OtherBLUE CROSS BLUE SHIELD
MA54946OtherFALLON COMM HEALTH PLAN
MAAA226OtherHARVARD PILGRIM
MA0178136Medicaid
2073241OtherCIGNA
MA214167OtherTUFTS HEALTH PLAN
MA3310128OtherAETNA HEALTHCARE
MAJ25407OtherBLUE CROSS BLUE SHIELD
MAA34554Medicare ID - Type Unspecified