Organization
JARED MALLALIEU, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARED EMERSON MALLALIEU D.O. (OWNER/DIRECTOR)
(410) 544-4600
Entity
Organization
Contact information
Practice address
484 RITCHIE HWY, SUITE 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
—
174406
MEDICARE
MD
01
—
242301
JHHC
MD
01
—
D92MJE
CAREFIRST
MD
01
—
U993
CAREFIRST
DC
Enumeration date
07/27/2009
Last updated
08/17/2015
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