Healthcare Provider Details

I. General information

NPI: 1265893127
Provider Name (Legal Business Name): MALLORY ANN UCCHINO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9471 MARKET ST STE A
NORTH LIMA OH
44452-8702
US

IV. Provider business mailing address

9471 MARKET ST STE A
NORTH LIMA OH
44452-8702
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-7100
  • Fax: 330-758-0347
Mailing address:
  • Phone: 330-726-7100
  • Fax: 330-758-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.013109CTR
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: