Healthcare Provider Details

I. General information

NPI: 1669463212
Provider Name (Legal Business Name): MARIA C. MALLARINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1782 OAK ST
SARASOTA FL
34236-7537
US

IV. Provider business mailing address

1782 OAK ST
SARASOTA FL
34236-7537
US

V. Phone/Fax

Practice location:
  • Phone: 941-544-2371
  • Fax:
Mailing address:
  • Phone: 941-544-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME63160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: