Individual
DR. CHARLES J. MALLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
988 OAK RIDGE TPKE, SUITE 350, OAK RIDGE, TN 37830-6930
(865) 483-7030
(865) 483-3954
Mailing address
988 OAK RIDGE TPKE, SUITE 350, OAK RIDGE, TN 37830-6930
(865) 483-7030
(865) 483-3954
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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