Mallory, Brenda Susan

Mallory, Brenda Susan is an individual health care provider with primary practice located at 601 W 2Nd St , Bloomington IN 47403-2317. She recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as her primary health care specialty. Mallory, Brenda Susan can be contacted via phone (812) 353-6821.

Contact Information

Primary practice address
601 W 2Nd St Bloomington IN 47403-2317
Phone: (812) 353-6821
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X MD440148 Pennsylvania
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 191473-1 New York
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 01084397A Indiana

Profile Details

NPI number 1992707111
LBN Legal business name Mallory, Brenda Susan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2005
Last updated Sep 1st, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992707111 NPPES
New York MEDICAID 01417674
New York MEDICAID 1024982060001
New York Other 191473-1

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