Individual provider Active NPI

Tanya Denice Malone, D.O.

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1124136007
Registry record updated Jun 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS010061L Issued in PA
Practice address
2840 W Dauphin St
Philadelphia, PA 19132-4627
Phone
(215) 685-2403
Fax
(215) 685-2440
NPI assigned
Aug 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS010061L PA Primary

Addresses

Primary practice location

2840 W Dauphin St
Philadelphia, PA 19132-4627

Mailing address

1429 E Johnson St
Philadelphia, PA 19138-1107
Phone (215) 407-8208

Other identifiers 1

IdentifierTypeStateIssuer
0017854770002MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070601000141 PA Practitioner - Family Practice 5193823987 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of PhiladelphiaGroup PAC ID 6305758723, 86 clinicians

Practice addresses (Care Compare)

2840 W Dauphin St
Philadelphia, PA 19132-4627
Phone (215) 685-2411

4400 Haverford Ave
Philadelphia, PA 19104-1361
Phone (215) 685-7630

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS010061LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
City of Philadelphia CurrentSince Mar 26, 2011 Accepting new patients
City of Philadelphia CurrentSince Mar 26, 2011 Accepting new patients
City of Philadelphia Current Accepting new patients
City of Philadelphia Past Accepting new patients

Locations

4400 Haverford Ave
#4
Philadelphia, PA 19104
Phone (215) 685-7600

2840 W Dauphin St
Philadelphia, PA 19132
Phone (215) 685-2400

1101 Market St
Fl 10
Philadelphia, PA 19107

Interoperability endpoints

  • Direct secure messaging: tanya.malone@pdphahs.eclinicaldirectplus.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339113600000",
    "number": "1124136007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1429 E JOHNSON ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191381107",
            "telephone_number": "215-407-8208",
            "fax_number": "215-685-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2840 W DAUPHIN ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191324627",
            "telephone_number": "215-685-2403",
            "fax_number": "215-685-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALONE",
        "first_name": "TANYA",
        "middle_name": "DENICE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2012-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS010061L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017854770002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.