Individual
LISA A MALONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
263 FARMINGTON AVE, EMERGENCY MEDICINE, FARMINGTON, CT 06030-0001
(860) 679-3486
(860) 679-3489
Mailing address
65 KANE ST, PROVIDER ENROLLMENT, WEST HARTFORD, CT 06119-2110
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000034
CT
Other
Enumeration date
11/26/2005
Last updated
01/13/2023
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