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General NPI Number Information
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NPI Number | 1164861522
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Entity Type | Individual
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Provider Name | MALLORY E WAUTHIER D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 9100 BABCOCK BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15237-5815
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Country | US
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Telephone | 941-745-7257
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Fax |
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Provider Business Mailing Address
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Address Line | 4885 MCKNIGHT RD STE 279
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City | PITTSBURGH
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State | PA
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Zip | 15237-3400
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Country | US
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Telephone |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OS018165
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License Number State | PA
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