Provider Demographics
NPI:1871754689
Name:DR THOMAS A MALONE, MD PA
Entity type:Organization
Organization Name:DR THOMAS A MALONE, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-963-7070
Mailing Address - Street 1:224 NE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2318
Mailing Address - Country:US
Mailing Address - Phone:864-963-7070
Mailing Address - Fax:864-963-5770
Practice Address - Street 1:224 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2318
Practice Address - Country:US
Practice Address - Phone:864-963-7070
Practice Address - Fax:864-963-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10971207Q00000X
SC28885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD175580281Medicaid
SCD175580281Medicaid