DR. CHARLES J. MALLO (NPI# 1558333492) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558333492 |
| Entity Type | Individual |
| Full Name | DR. CHARLES J. MALLO |
| Credential | M.D. |
| Practice Address |
988 Oak Ridge Tpke Suite 350 Oak Ridge TN 37830-6930 |
| Practice Telephone | 8654837030 |
| Practice Fax Number | 8654833954 |
| Mailing Telephone | 8654837030 |
| Mailing Fax Number | 8654833954 |
| Enumeration Date | 2006-02-05 |
| Last Update Date | 2014-05-29 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 132331-1 | NY | Other Service Providers |
| N | 208600000X | Surgery | 132331 | NY | Allopathic & Osteopathic Physicians |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
49148 | TN | Allopathic & Osteopathic Physicians |
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
132331 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00593242 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063611788 | Charles J. Mallo | Psychiatry & Neurology | 216 Vaughan St, Portland, ME 04102-3204 | 2007-07-12 |
| Street Address |
988 OAK RIDGE TPKE SUITE 350 |
| City | OAK RIDGE |
| State | TN |
| Zip Code | 37830-6930 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902898398 | Paula Jane Marshall | Pharmacist | 988 Oak Ridge Tpke, Oak Ridge, TN 37830-6919 | 2005-08-22 |
| 1316262777 | Charles B Orton | Internal Medicine | 988 Oak Ridge Tpke, Ste 200, Oak Ridge, TN 37830-6930 | 2010-03-29 |
| 1972733616 | Venkata C Gourineni | Internal Medicine | 988 Oak Ridge Tpke, Suite 200, Oak Ridge, TN 37830-6930 | 2009-07-15 |
| 1154548105 | Kathryn J Hayes | Obstetrics & Gynecology | 988 Oak Ridge Tpke, Suite 140, Oak Ridge, TN 37830-6930 | 2007-04-19 |
| 1891816500 | Physicians Diagnostic Services | Radiology | 988 Oak Ridge Tpke, Physicians Plaza, Ste L-40, Oak Ridge, TN 37830-6930 | 2007-04-02 |
| 1003931320 | Jean F. Marler | Nurse Practitioner | 988 Oak Ridge Tpke, Suite 140 Physicians Plaza, Oak Ridge, TN 37830-6930 | 2007-03-20 |
| 1932254430 | Tennessee Orthopaedic Clinics PC | Clinic/Center | 988 Oak Ridge Tpke, Suite 100, Oak Ridge, TN 37830-6930 | 2007-01-24 |
| 1376607051 | Mmc Healthworks LLC | Clinic/Center | 988 Oak Ridge Tpke, Physicians Plaza Suite L-50, Oak Ridge, TN 37830-6930 | 2006-12-20 |
| 1700963857 | Henry C Hooker | Psychiatry & Neurology | 988 Oak Ridge Tpke, Suite 300, Oak Ridge, TN 37830-6930 | 2006-11-01 |
| 1639269822 | Obstetric & Gyncologic Assocs of Oak Ridge | Obstetrics & Gynecology | 988 Oak Ridge Tpke, Suite 140, Oak Ridge, TN 37830 | 2006-10-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194388702 | Oak Ridge Pharmacy | Pharmacy | 854 Main St W, Oak Ridge, TN 37830 | 2019-04-18 |
| 1134682693 | Mac's Pharmacy Oak Ridge, LLC | Pharmacy | 45 New York Avenue, Oak Ridge, TN 37830 | 2019-04-11 |
| 1689153876 | Tapuwa Martin Chikowore | Dentist | 377 S Illinois Ave, Oak Ridge, TN 37830 | 2018-08-09 |
| 1710475660 | Oak Ridge Smiles Dentistry, PC | Dentist | 377 S. Illinois Ave., Oak Ridge, TN 37830 | 2018-04-26 |
| 1417344763 | Heather Cupp | Social Worker | 723 Emory Valley Road, Oak Ridge, TN 37830 | 2015-04-23 |
| 1366701534 | Quality Care From The Heart | Preferred Provider Organization | 144 Newport Drive, Oak Ridge, TN 37830 | 2012-05-09 |
| 1578838223 | Second Chance Recovery In Faith, Inc | Community/Behavioral Health | 234 W Tennessee Ave, Oak Ridge, TN 37830 | 2012-03-14 |
| 1720364615 | Douglas Miller | Pharmacist | 1299 Oak Ridge Turnpike, Oak Ridge, TN 37830 | 2011-10-24 |
| 1619263852 | Namratha Reddy Vontela | Internal Medicine | 200 New York Ave Ste 200, Oak Ridge, TN 37830 | 2011-06-27 |
| 1356658165 | Fred Lewis Stephens | Social Worker | 150 E Division Rd Ste 10, Oak Ridge, TN 37830 | 2010-09-01 |
| Find all providers in zip 37830 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427394220 | Frances L. Cross, Md, Pllc | Surgery | 800 Oak Ridge Tpke, Suite A200, Oak Ridge, TN 37830-6957 | 2012-12-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215548375 | Center for Vein Restoration Tn Pllc | Surgery | 6005 Park Ave Ste 225b, Memphis, TN 38119-5207 | 2020-08-12 |
| 1972129534 | Aadi, LLC | Surgery | 7425 Ziegler Rd Ste 101, Chattanooga, TN 37421-4178 | 2020-06-19 |
| 1871002055 | Sumner Physician Practices LLC | Surgery | 225 Big Station Camp Blvd Ste 211, Gallatin, TN 37066-8466 | 2017-09-20 |
| 1679969729 | Jeffrey Thomas Johnston | Surgery | 910 Madison Ave Fl 2, Memphis, TN 38103-3403 | 2015-04-15 |
| 1811330830 | Patrick Yu | Surgery | 1222 Trotwood Ave Ste 211, Columbia, TN 38401-6405 | 2013-04-09 |
| 1578838629 | Karen Parks Rudolph | Surgery | 2108 E 3rd Street, Chattanooga, TN 37404-1622 | 2012-03-21 |
| 1588857148 | James Eric Gardner, Md | Surgery | 400 Market Blvd, Collierville, TN 38017-6516 | 2007-08-27 |
| 1437356482 | Vascular Wellness Center Inc | Surgery | 1720 West Ave Ste 103, Crossville, TN 38555-6066 | 2007-07-02 |
| 1528289808 | Shaun Michael Stickley | Surgery | 1325 Eastmoreland Ave Ste 310, Memphis, TN 38104-7544 | 2007-05-02 |
| 1164598876 | Patrick W Meacham | Surgery | 353 New Shackle Island Rd Suite 348c, Hendersonville, TN 37075 | 2006-11-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.