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General NPI Number Information
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NPI Number | 1609163765
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Entity Type | Individual
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Provider Name | MALLORY J. LOVETT O.D
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Gender | Female
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 6509 DEMOCRACY BLVD
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City | BETHESDA
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State | MD
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Zip | 20817-1639
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Country | US
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Telephone | 301-897-8484
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Fax |
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Provider Business Mailing Address
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Address Line | 508 FLEETWOOD ST
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City | SILVER SPRING
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State | MD
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Zip | 20910-5509
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Country | US
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Telephone | 215-901-9505
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA2247
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License Number State | MD
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