Individual
MALLORY DES CHAMPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7901 4TH AVE STE A20, BROOKLYN, NY 11209-3957
(718) 491-5800
(718) 748-2151
Mailing address
1150 DOUGLAS PIKE, SMITHFIELD, RI 02917-1291
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
06/03/2019
Last updated
12/23/2019
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