Provider Demographics
NPI:1487881983
Name:MARONEY, SEAN KEVIN (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:KEVIN
Last Name:MARONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BON AIR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1134
Mailing Address - Country:US
Mailing Address - Phone:415-924-2515
Mailing Address - Fax:415-924-2661
Practice Address - Street 1:5 BON AIR RD STE 101
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1134
Practice Address - Country:US
Practice Address - Phone:415-924-2515
Practice Address - Fax:415-924-2661
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA282539208600000X, 208C00000X
CAA135520208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110163034AMedicaid