Mary Mallavarapu MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

121643 Issued in NY

Legal business name

MARY MALLAVARAPU MD

Practice address

971 Route 45
Suite 112
Pomona, NY 10970-3500

Phone

(845) 354-8054

Fax

(845) 354-1807

NPI assigned

May 7, 2009

Organization subpart

Yes

Parent organization

MARY MALLAVARAPU MDAs reported in NPPES

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

Authorized official

Name

Ms. Anita Soares, MBA

Title

Office Manager

Phone

(845) 354-8054

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Mary T Mallavarapu2 organizations share this tax ID, including this one

Part of

Mary T Mallavarapu

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mary Mallavarapu MD

  • Pediatrics Physician
  • New City, NY
  • NPI 1124252705
  NPD tax ID

Locations

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

{
    "created_epoch": "1241654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241654400000",
    "number": "1669606547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "971 ROUTE 45",
            "address_2": "SUITE 112",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "109703500",
            "telephone_number": "845-354-8054",
            "fax_number": "845-354-1807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 ROUTE 45",
            "address_2": "SUITE 112",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "109703500",
            "telephone_number": "845-354-8054",
            "fax_number": "845-354-1807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY MALLAVARAPU MD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY MALLAVARAPU MD",
        "enumeration_date": "2009-05-07",
        "last_updated": "2009-05-07",
        "status": "A",
        "authorized_official_last_name": "SOARES",
        "authorized_official_first_name": "ANITA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "845-354-8054",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "121643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00515435",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joel A Marcus, MD
• Yvonne Marfo
• Marita Smith Dentistry, PC
• Mark Fagelman, M.D., P.C.
• Charles M Marvin, DDS
• Joseph Anthony Matera Jr., DPT
• Beenaroy Mathew, RN
• Gigi T Mathew
• Valsamma Mathew, FNP
• Tierney Matthews, N.P.

• Pediatrics Physician in Pomona, NY
• Providers in Pomona, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.