Fossa, Mallory

Fossa, Mallory is an sole proprietor health care provider with primary practice located at 282 Washington St , Hartford CT 06106-3322. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Anesthesiology. Allopathic & Osteopathic Physicians / Pediatric Anesthesiology is her primary health care specialty. Fossa, Mallory can be contacted via phone (860) 837-5207.

Contact Information

Primary practice address
282 Washington St Hartford CT 06106-3322
Phone: (860) 837-5207
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 95003548 California
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 12.008276 Connecticut
Allopathic & Osteopathic Physicians / Pediatric Anesthesiology 207LP3000X 95003548 California

Profile Details

NPI number 1780059030
LBN Legal business name Fossa, Mallory
Credentials PNP-PC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 10th, 2015
Last updated Sep 12th, 2022 - about 2 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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