Healthcare Provider Details

I. General information

NPI: 1831154285
Provider Name (Legal Business Name): AMARJITH NITTE MALLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WILSON AVENUE THE WASHINGTON HOSPITAL
WASHINGTON PA
15301
US

IV. Provider business mailing address

PO BOX 640631 EMERGENCY MEDICINE OF WASHINGTON HOSPITAL
PITTSBURGH PA
15264-0631
US

V. Phone/Fax

Practice location:
  • Phone: 724-223-3342
  • Fax: 610-617-6280
Mailing address:
  • Phone: 610-668-6491
  • Fax: 610-617-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD047120L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: