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General NPI Number Information
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NPI Number | 1912081266
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Entity Type | Individual
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Provider Name | GENEVIEVE BROWN MALLON M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 960 37TH STREET SUITE 101
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City | VERO BEACH
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State | FL
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Zip | 32960
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Country | US
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Telephone | 772-562-5662
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 191
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City | ROCKLAND
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State | DE
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Zip | 19732-0191
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Country | US
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Telephone | 302-651-6212
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Fax | 302-651-4945
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 78157
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME78157
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME78157
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License Number State | FL
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