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General NPI Number Information
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NPI Number | 1508834854
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Entity Type | Individual
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Provider Name | JUAN J. MALLARI MD
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Gender | Male
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Dates
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Enumeration Date | 03/12/2006
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 1440 MAIN STREET
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City | WALTHAM
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State | MA
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Zip | 02451
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Country | US
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Telephone | 781-891-9300
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Fax | 781-891-9305
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Provider Business Mailing Address
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Address Line | PO BOX 1849
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City | LEWISTON
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State | ME
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Zip | 04241-1849
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Country | US
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Telephone | 207-784-2554
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Fax | 207-777-5363
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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 | 037082
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 78874
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA08043200
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License Number State | NJ
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