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General NPI Number Information
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NPI Number | 1427037951
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Entity Type | Individual
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Provider Name | JOHN KENNETH MALLEN MD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 32 STILES RD STE 204
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City | SALEM
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State | NH
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Zip | 03079
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Country | US
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Telephone | 603-894-9898
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Fax | 603-894-6270
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Provider Business Mailing Address
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Address Line | 32 STILES RD STE 204
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City | SALEM
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State | NH
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Zip | 03079
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Country | US
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Telephone | 603-894-9898
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Fax | 603-894-6270
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 10052
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 154434
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License Number State | MA
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