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NPI Code Detail

MEDICARE: SAMANTHA MALLIK

MEDICARE: SAMANTHA MALLIK
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
1133V00000XRegistered DietitianDN004752PA

General Provider Information

NPI Number : 1316344591
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA MALLIK
Provider Business Mailing Address
First Line : 1512 SOUTH ST
Second Line : 1ST FLOOR
City : PHILADELPHIA
State : PA
Zip : 19146-1636
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1512 SOUTH ST
Second Line : 1ST FLOOR
City : PHILADELPHIA
State : PA
Zip : 19146-1636
Country : US
Telephone Number : 267-239-5637
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2014
Last Update Date : 12/03/2014

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Directions to “ SAMANTHA MALLIK ” Practice Location

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