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General NPI Number Information
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NPI Number | 1003802414
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Entity Type | Organization
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Legal Business Name | JEFFERSON ASSOC IN INTERNAL MED
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 575 COAL VALLEY RD SUITE 405
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City | CLAIRTON
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State | PA
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Zip | 15025-3730
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Country | US
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Telephone | 412-466-6161
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Fax | 412-466-0614
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Provider Business Mailing Address
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Address Line | 575 COAL VALLEY RD SUITE 405
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City | CLAIRTON
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State | PA
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Zip | 15025-3730
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Country | US
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Telephone | 412-466-6161
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Fax | 412-466-0614
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Authorized Official
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Title or Position | MD OWNER OF CORP
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Name | MICHAEL I MALLINGER
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Credential | MD
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Telephone | 412-466-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MD016592E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD016592E
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License Number State | PA
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