Individual
JOHN ROBERT MALLOY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 FLYNN AVE, BURLINGTON, VT 05401-5301
(802) 658-0400
Mailing address
1589 PRINDLE RD, CHARLOTTE, VT 05445-9180
(802) 425-5442
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
042-0008866
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0VN0340
—
VT
Enumeration date
07/06/2006
Last updated
08/21/2009
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