Individual
LINDA MALONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
721 FAIRFAX AVE, 3RD FLOOR, NORFOLK, VA 23507-2007
(757) 446-5915
(757) 446-5089
Mailing address
PO BOX 936, NORFOLK, VA 23501-0936
(757) 446-5915
(757) 446-5089
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110003091
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-017
TRICARE/CHAMPUS
VA
05
—
1669705802
—
VA
Enumeration date
09/04/2009
Last updated
12/21/2009
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