Healthcare Provider Details
I. General information
NPI: 1821581893
Provider Name (Legal Business Name): MALLORY SCHAFFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/13/2018
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3631 PENNS VALLEY RD
SPRING MILLS PA
16875-8011
US
IV. Provider business mailing address
1800 E PARK AVE
STATE COLLEGE PA
16803-6701
US
V. Phone/Fax
- Phone: 814-422-8873
- Fax: 814-422-8037
- Phone: 814-231-7000
- Fax: 814-238-0790
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | MD476897 |
| License Number State | PA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 390200000X |
| Taxonomy | Student in an Organized Health Care Education/Training Program |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207QS0010X |
| Taxonomy | Sports Medicine (Family Medicine) Physician |
| License Number | MD476897 |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: