MEDICARE: DR. THOMAS MALLON DANIEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	35.022428	OH

General Provider Information

NPI Number	:	1962536144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS MALLON DANIEL M.D.

Provider Business Mailing Address
First Line	:	43 LAUREL LAKE DR
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-2159
Country	:	US
Telephone Number	:	330-655-4065
Fax Number	:

Provider Business Practice Location Address
First Line	:	10900 EUCLID AVENUE
Second Line	:	CWRU CENTER FOR GLOBAL HEALTH
City	:	CLEVELAND
State	:	OH
Zip	:	44106-7286
Country	:	US
Telephone Number	:	216-368-6323
Fax Number	:	216-368-4825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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