Jared Emerson Mallalieu, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

H68311 Issued in MD

Practice address

484 Ritchie Hwy Ste a
Severna Park, MD 21146-2961

Phone

(410) 544-4600

Fax

(410) 544-0997

NPI assigned

Dec 27, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ross Van Antwerp DO MPH PA Laser Center of Maryland

  • Health Service Clinic/Center
  • Severna Park, MD
  • NPI 1356537443
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435190400000",
    "number": "1033393996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10845 PHILADELPHIA RD",
            "city": "WHITE MARSH",
            "state": "MD",
            "postal_code": "211621717",
            "telephone_number": "410-335-0008",
            "fax_number": "410-335-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "484 RITCHIE HWY STE A",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211462961",
            "telephone_number": "410-544-4600",
            "fax_number": "410-544-0997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLALIEU",
        "first_name": "JARED",
        "middle_name": "EMERSON",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-27",
        "last_updated": "2015-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MD",
            "license": "H68311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "95050303",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE",
            "identifier": "417363500",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1622382ZF69",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JHHC",
            "identifier": "242301",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "U993  0001",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Daniel Mahoney, ATC/L
• Katrina Marie Mamuzich, AAS, PTA, COPTA
• Radmila Mandelblatt, MA, OT L
• Farida Alif Manejwala, PT
• Anthony Silivio Manganelli, D.C.
• David Everett Mank, LCPC

• Surgery Physician in Severna Park, MD
• Providers in Severna Park, MD by specialty
• Surgery Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.