Individual
GIRIDHAR MALLYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
51 N 39TH ST, PHILADELPHIA, PA 19104-2640
(215) 662-8777
(215) 243-4601
Mailing address
51 N 39TH ST, PHILADELPHIA, PA 19104-2640
(215) 662-8777
(215) 243-4601
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD427990
PA
Other
Enumeration date
07/06/2006
Last updated
03/10/2011
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