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General NPI Number Information
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NPI Number | 1245558832
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Entity Type | Individual
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Provider Name | RADMILA MALLAH CRNP
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Gender | Female
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Dates
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Enumeration Date | 05/07/2010
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 9892 BUSTLETON AVE STE 101
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City | PHILADELPHIA
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State | PA
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Zip | 19115-2138
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Country | US
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Telephone | 215-676-2741
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Fax | 215-676-2796
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Provider Business Mailing Address
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Address Line | 3500 N BROAD ST RM 1A
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City | PHILADELPHIA
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State | PA
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Zip | 19140-4106
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Country | US
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Telephone | 215-707-2433
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP010776
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License Number State | PA
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