DR. CHARLES J. MALLO M.D. NPI 1558333492

NPI Information

NPI: 1558333492
Provider Name: DR. CHARLES J. MALLO, M.D.
Classification: Surgery - 2086S0129X
Entity Type: Individual

Specialization: Vascular Surgery

Address:
988 OAK RIDGE TPKE
SUITE 350
OAK RIDGE, TN
ZIP 37830
Phone: (865) 483-7030
Get Directions

DR. Charles J. Mallo, M.D. is a vascular surgery surgery in Oak Ridge, TN. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. DR. Charles J. Mallo, M.D. NPI is 1558333492. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

988 OAK RIDGE TPKE
SUITE 350
OAK RIDGE, TN
ZIP 37830-930
Phone: (865) 483-7030
Fax: (865) 483-3954

The enumeration date for this NPI number is 2/5/2006 and was last updated on 5/29/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		132331-1	NEW YORK	No
2	208600000X	Surgery		132331	NEW YORK	No
3	2086S0129X	Surgery	Vascular Surgery	132331	NEW YORK	No
4	2086S0129X	Surgery	Vascular Surgery	49148	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	AA0471	MEDICARE PIN	NEW YORK
2	00593242	MEDICAID	NEW YORK
3	103I020650	MEDICARE PIN	TENNESSEE
4	B71662	MEDICARE UPIN	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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