Individual provider Active NPI

Demario J Malone

  • Student in an Organized Health Care Education/Training Program
  • Philadelphia, PA
National Provider Identifier
1346036456
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1412 Fairmount Ave
Philadelphia, PA 19130-2908
Phone
(215) 235-9600
NPI assigned
Apr 16, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1412 Fairmount Ave
Philadelphia, PA 19130-2908

Mailing address

1412 Fairmount Ave
Philadelphia, PA 19130-2908
Phone (215) 235-9600

Other practice location 1

401 W Allegheny Ave
Philadelphia, PA 19133-3644
Phone (215) 291-2500

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
I20260504005591 PA Order and Referring Only - Family PracticePractitioner - Family Practice 6305314816

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Interoperability endpoints

  • Direct secure messaging: demario.malone.p1@direct.dvch.nextgenshare.com

NPI Registry JSON

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

{
    "created_epoch": "1744761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1346036456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 FAIRMOUNT AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191302908",
            "telephone_number": "215-235-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 FAIRMOUNT AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191302908",
            "telephone_number": "215-235-9600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 W Allegheny Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191333644",
            "country_code": "US",
            "telephone_number": "215-291-2500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALONE",
        "first_name": "DEMARIO",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-16",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.