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General NPI Number Information
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NPI Number | 1073923132
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Entity Type | Individual
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Provider Name | MALLORY LOSTUMBO
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Gender | Female
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 1201 SEVEN LOCKS RD STE 201
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City | ROCKVILLE
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State | MD
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Zip | 20854-2963
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Country | US
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Telephone | 301-881-7995
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Fax | 240-236-9865
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone |
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Fax | 240-236-9865
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D83313
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License Number State | MD
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