Healthcare Provider Details

I. General information

NPI: 1972731115
Provider Name (Legal Business Name): MALLORY ANNE BALMER-SWAIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALLORY ANNE BALMER DO

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE SANDS CONSTELLATION HEART INSTITUTE
ROCHESTER NY
14621-3022
US

IV. Provider business mailing address

1425 PORTLAND AVE SANDS CONSTELLATION HEART INSTITUTE
ROCHESTER NY
14621-3022
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-5320
  • Fax: 585-442-5526
Mailing address:
  • Phone: 585-442-5320
  • Fax: 585-442-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP1446
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number278446
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: