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General NPI Number Information
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NPI Number | 1023595246
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Entity Type | Individual
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Provider Name | HANEEN M. A. MALLAH MD
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Gender | Female
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 1600 SW ARCHER RD
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City | GAINESVILLE
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State | FL
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Zip | 32610-0002
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Country | US
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Telephone | 352-273-8737
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Fax | 806-743-3143
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Provider Business Mailing Address
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Address Line | PO BOX 100225
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City | GAINESVILLE
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State | FL
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Zip | 32610-0225
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Country | US
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Telephone | 352-273-8737
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME166013
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License Number State | FL
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