Healthcare Provider Details

I. General information

NPI: 1649273715
Provider Name (Legal Business Name): CHRISTOPHER T MALLAVARAPU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MAIN ST
OLEAN NY
14760-1513
US

IV. Provider business mailing address

86 NAVESINK AVE
RUMSON NJ
07760-2043
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-2600
  • Fax:
Mailing address:
  • Phone: 337-296-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD29903
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number183914
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number183914
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: