Individual
MS. RANDA DIANA ELMALLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-0288
Mailing address
881 E EMERALD TER, NIXA, MO 65714-9457
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2022029948
MO
207X00000X
Orthopaedic Surgery Physician
286499
MA
207X00000X
Orthopaedic Surgery Physician
ME168335
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200113384
—
MO
Enumeration date
03/28/2016
Last updated
10/03/2024
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