Healthcare Provider Details

I. General information

NPI: 1558377648
Provider Name (Legal Business Name): MARINO D MALLOZZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 N READING RD SUITE 301
EPHRATA PA
17522-9802
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-733-6546
  • Fax: 717-733-6010
Mailing address:
  • Phone: 717-733-6546
  • Fax: 717-733-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD056528L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD056528L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: