Healthcare Provider Details

I. General information

NPI: 1902961063
Provider Name (Legal Business Name): MALLIKA M BHANDARY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NUTT ROAD
PHOENIXVILLE PA
19460-3906
US

IV. Provider business mailing address

51 N 39TH ST
PHILADELPHIA PA
19104-2640
US

V. Phone/Fax

Practice location:
  • Phone: 610-983-1166
  • Fax: 610-983-1612
Mailing address:
  • Phone: 215-662-8963
  • Fax: 610-983-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD428152
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD428152
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License NumberMD428152
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: