Individual
MR. NORMAN ROBERT MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
360 BROADWAY STE 100, BANGOR, ME 04401-3979
(207) 907-3550
(207) 907-3562
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8941
(207) 777-4397
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-692
ME
Other
Enumeration date
09/21/2006
Last updated
02/03/2022
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