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
Health care specialties
| Specialty | Code | License # | 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 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992707111 | NPPES |
| New York | MEDICAID | 01417674 | |
| New York | MEDICAID | 1024982060001 | |
| New York | Other | 191473-1 |
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