Provider Demographics
NPI:1679518997
Name:MALONEY, GENEVIEVE M (MD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:M
Last Name:MALONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GENEVIEVE
Other - Middle Name:M
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2864 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3740
Mailing Address - Country:US
Mailing Address - Phone:906-632-5200
Mailing Address - Fax:
Practice Address - Street 1:2864 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3740
Practice Address - Country:US
Practice Address - Phone:906-632-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050953207Q00000X
MI4301079452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000383666OtherBLUE CROSS
IN000000580323OtherBCBS
IN200183770Medicaid
IN200183770Medicaid
INH14510Medicare UPIN
738460WWWWMedicare PIN
239010LMedicare PIN