Provider Demographics
NPI:1548936347
Name:MALONE, ROBERT W (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:MALONE
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 1:355 HEBRON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:VA
Mailing Address - Zip Code:22727-3141
Mailing Address - Country:US
Mailing Address - Phone:434-979-0090
Mailing Address - Fax:
Practice Address - Street 1:355 HEBRON VALLEY RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727-3141
Practice Address - Country:US
Practice Address - Phone:434-979-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055466261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch