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General NPI Number Information
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NPI Number | 1457914079
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Entity Type | Individual
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Provider Name | CHRISTOPHER ADAM MALLARD MD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 330 BROOKLINE AVE # FD221A
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City | BOSTON
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State | MA
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Zip | 02215-5400
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Country | US
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Telephone | 617-667-5048
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Fax |
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Provider Business Mailing Address
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Address Line | 49 MARION ST APT 7A
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City | BROOKLINE
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State | MA
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Zip | 02446-4481
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Country | US
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Telephone | 401-996-8809
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 1014652
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License Number State | MA
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