Individual
DR. WALTER N. MALLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1101 JOHNSON AVE, MYRTLE BEACH, SC 29577-1893
(843) 477-0177
(843) 518-4022
Mailing address
PO BOX 1407, TAPPAHANNOCK, VA 22560-1407
(804) 370-4093
(804) 443-0439
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101027084
VA
207RC0000X
Cardiovascular Disease Physician
Primary
0101027084
VA
207RI0011X
Interventional Cardiology Physician
0101027084
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6075886
—
VA
Enumeration date
10/13/2006
Last updated
10/31/2019
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