MEDICARE: CHRISTOPHER MALLOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor		ME

General Provider Information

NPI Number	:	1275004996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MALLOY

Provider Business Mailing Address
First Line	:	85 SEQUOIA LN
Second Line	:
City	:	NORTH WATERBORO
State	:	ME
Zip	:	04061-4946
Country	:	US
Telephone Number	:	207-808-1446
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 SEQUOIA LN
Second Line	:
City	:	NORTH WATERBORO
State	:	ME
Zip	:	04061-4946
Country	:	US
Telephone Number	:	207-808-1446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	12/06/2018

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Directions to “ CHRISTOPHER MALLOY ” Practice Location

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