Mohan Mallam, M.D.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

A42919 Issued in CA

Practice address

303 E Buena Vista St
Barstow, CA 92311-2803

Phone

(760) 256-4601

Fax

(760) 256-0310

NPI assigned

Aug 10, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

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 Medicine

Interoperability endpoints

• Direct secure messaging: mmallam@yourcarecommunity.org

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205193600000",
    "number": "1538161443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E BUENA VISTA ST",
            "city": "BARSTOW",
            "state": "CA",
            "postal_code": "923112803",
            "telephone_number": "760-256-4601",
            "fax_number": "760-256-0310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 E BUENA VISTA ST",
            "city": "BARSTOW",
            "state": "CA",
            "postal_code": "923112803",
            "telephone_number": "760-256-4601",
            "fax_number": "760-256-0310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLAM",
        "first_name": "MOHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2008-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A42919",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A42919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A429190",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB73093F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maithri N. Weerasinghe MD Inc (Dr Mike's Walk In Clinic)
• Make It Happen Conglomerate Corp (Make It Happen Center)
• Tracy L Malan, RPT
• Desrianna Maldonado
• Jlanamae Kaleipoipe Maldonado
• Amanda Malone
• Karen L. Manildi
• Michael R Manolescu, M.D.
• Meredith Manuel, LVN
• April Manzo

• Geriatric Medicine (Internal Medicine) Physician in Barstow, CA
• Providers in Barstow, CA by specialty
• Geriatric Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; 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.