Susan Regina Mallery, DDS

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

30016966 Issued in OH

Practice address

305 W 12TH Ave
College of Dentistry Ohio State University
Columbus, OH 43210-1267

Phone

(614) 292-5892

Fax

(614) 292-9384

NPI assigned

Feb 16, 2006

Last updated

Mar 8, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Pathology

Education

Ohio State University College of Dentistry, 1981

Medicare assignment

May accept Medicare assignment

Group practices

Oral Pathology Consultants Laboratory, LLC - John R Kalmar, DMD PHDGroup PAC ID 1153675970, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oral Pathology Consultants Laboratory, LLC

  • Oral and Maxillofacial Pathology Dentistry
  • Columbus, OH
  • NPI 1790272748
  Medicare reassignment Care Compare group NPD
• Ohio State Dental Faculty Practice Inc

  • Dentist
  • Columbus, OH
  • NPI 1164537684
  Medicare reassignment NPD

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

{
    "created_epoch": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331164800000",
    "number": "1083688865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W 12TH AVE",
            "address_2": "COLLEGE OF DENTISTRY OHIO STATE UNIVERSITY",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101267",
            "telephone_number": "614-292-5892",
            "fax_number": "614-292-9384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W 12TH AVE",
            "address_2": "COLLEGE OF DENTISTRY OHIO STATE UNIVERSITY",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101267",
            "telephone_number": "614-292-5892",
            "fax_number": "614-292-9384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLERY",
        "first_name": "SUSAN",
        "middle_name": "REGINA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-16",
        "last_updated": "2012-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "OH",
            "license": "30016966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ubah Malin, LPN
• Jean A Malinky, CNS
• Melissa Marie Malinky, FNP
• Kurt Malkoff, PH.D.
• Rama K. Mallampalli, MD
• Keith Edward Mallett Jr.
• Tricia Lynne Malley, CNP
• Hema Mallick, DDS
• Monisha K Mallik, DC
• Angela Monique Mallory, CDCA

• Oral and Maxillofacial Pathology Dentistry in Columbus, OH
• Providers in Columbus, OH by specialty
• Oral and Maxillofacial Pathology Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.