Individual
MALLORY WALSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
500 MARTHA JEFFERSON DR, CHARLOTTESVILLE, VA 22911
(434) 654-7580
(434) 654-7582
Mailing address
PO BOX 79777, BALTIMORE, MD 21279-0777
(434) 654-7794
(434) 654-7582
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004076
VA
Other
Enumeration date
11/11/2011
Last updated
07/03/2018
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