Provider Demographics
NPI:1336186782
Name:MALONEY, SEAN T (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:T
Last Name:MALONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 BLAKELY RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-4417
Mailing Address - Country:US
Mailing Address - Phone:802-847-2055
Mailing Address - Fax:802-847-1688
Practice Address - Street 1:883 BLAKELY RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4417
Practice Address - Country:US
Practice Address - Phone:802-847-2055
Practice Address - Fax:802-847-1688
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014336207Q00000X
VT042.0013956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME305940099Medicaid
MESX4956Medicare PIN
ME305940099Medicaid
MESX4957Medicare PIN
MESX4956Medicare PIN