Individual
PRASHANTH A MALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12255 FAIR LAKES PKWY, FAIRFAX, VA 22033-3952
(703) 934-5700
Mailing address
2101 E JEFFERSON ST, KAISER PERMANENTE MEDICARE ENROLLMENT, ROCKVILLE, MD 20852-4908
(301) 816-2424
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
101244719
VA
Other
Enumeration date
05/08/2008
Last updated
11/23/2021
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