Healthcare Provider Details

I. General information

NPI: 1922668789
Provider Name (Legal Business Name): MALLORY BAREFOOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALLORY ZAINO MD

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S SOUTH ST STE 100
MOUNT AIRY NC
27030-4589
US

IV. Provider business mailing address

108 DORNACH WAY
ADVANCE NC
27006-7305
US

V. Phone/Fax

Practice location:
  • Phone: 336-698-4055
  • Fax: 336-940-3035
Mailing address:
  • Phone: 336-940-2407
  • Fax: 336-940-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2026-01982
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: