Provider Demographics
NPI:1962594895
Name:MALONE, PAUL G (PA-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:MALONE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:582 BLUE RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-2604
Mailing Address - Country:US
Mailing Address - Phone:540-425-7910
Mailing Address - Fax:540-583-5147
Practice Address - Street 1:582 BLUE RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2604
Practice Address - Country:US
Practice Address - Phone:540-425-7910
Practice Address - Fax:540-583-5147
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002686363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant