Individual
DR. CHARLES J. MALLO
Active
Individual
DR. CHARLES J. MALLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
132331-1
NY
208600000X
Surgery Physician
132331
NY
2086S0129X
Vascular Surgery Physician
132331
NY
2086S0129X
Vascular Surgery Physician
Primary
49148
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00593242
—
NY
Enumeration date
02/05/2006
Last updated
05/29/2014
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