Individual
JARED EMERSON MALLALIEU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
484 RITCHIE HWY STE A, SEVERNA PARK, MD 21146-2961
(410) 544-4600
(410) 544-0997
Mailing address
10845 PHILADELPHIA RD, WHITE MARSH, MD 21162-1717
(410) 335-0008
(410) 335-3113
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
H68311
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622382ZF69
MEDICARE
MD
01
—
242301
JHHC
MD
01
—
417363500
MEDICAL ASSISTANCE
MD
01
—
95050303
CAREFIRST
MD
01
—
U993 0001
CAREFIRST
DC
Enumeration date
12/27/2007
Last updated
06/25/2015
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