Victor Theodore Mallory, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA061966 Issued in PA

Practice address

100 N Academy Ave
Danville, PA 17822-9800

Phone

(570) 271-6211

NPI assigned

Oct 13, 2020

Last updated

Nov 14, 2024By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: vmallory301488@direct.geisinger.edu

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.

• Geisinger Clinic

  • Family Medicine Physician
  • Danville, PA
  • NPI 1366493868
  Medicare reassignment
• STC Pediatrics LLC

  dba St. Christopher's Pediatric Associates Emergency Medicine - E. Erie A

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Philadelphia, PA
  • NPI 1144864547
  Medicare reassignment
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023
  NPD
• Geisinger Clinic

  dba PrimeMed Medical Grp Moosic in collaboration w/Geisinger Clinic

  • Family Medicine Physician
  • Moosic, PA
  • NPI 1952718538
  NPD
• STC Pediatrics LLC

  dba St. Christopher's Pediatric Associates Infectious Disease - Jenkintown

  • Pediatric Infectious Diseases Physician
  • Jenkintown, PA
  • NPI 1003451345
  NPD
• STC Pediatrics LLC

  dba St. Christopher's Pediatric Associates Ophthalmology - Newtown Yardley

  • Ophthalmology Physician
  • Newtown, PA
  • NPI 1548141997
  NPD
• STC Pediatrics LLC

  dba St. Christopher's Pediatric Associates Immunology HIV - E. Erie Avenue

  • Pediatric Allergy/Immunology Physician
  • Philadelphia, PA
  • NPI 1003450420
  NPD (past)

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1316545304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13579",
            "city": "READING",
            "state": "PA",
            "postal_code": "196123579",
            "telephone_number": "215-427-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178229800",
            "telephone_number": "570-271-6211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 E Erie Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191341011",
            "country_code": "US",
            "telephone_number": "215-427-4820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "VICTOR",
        "middle_name": "THEODORE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-13",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA061966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martin G. Maksimak, M.D.
• Michal Maksimak, MD
• Christopher G. Malafronte, PA-C
• Daniel Maldonado, PHARM.D.
• Gayatri Malik, BDS
• William J. Malone, M.D.
• William J. Malone, D.O.
• Gwynne Maloney-Saxon, R.N.
• Brooke E. Maloney, PA-C
• John J. Maloney, CRNA

• Physician Assistant in Danville, PA
• Providers in Danville, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; 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.