Healthcare Provider Details

I. General information

NPI: 1760228563
Provider Name (Legal Business Name): MALLORY TAYLOR CAIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 CROSSINGS CT STE 101-103
PRINCE GEORGE VA
23875-1538
US

IV. Provider business mailing address

4600 MONTGOMERY RD STE 400
CINCINNATI OH
45212-2600
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-4357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010334
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: