Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101259788 | VA |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD045068 | DC |
NPI | 1285071118 |
---|---|
Provider Name | Nada Mallick |
First Address | Washington, DC 20010-2916 |
Second Address | Washington, DC 20010-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2013 |
Last Update Date | 11/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2014287839 | (05) | VA |