MALLORY LAKE (NPI# 1699149906) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699149906 |
| Entity Type | Individual |
| Full Name | MALLORY LAKE |
| Practice Address |
3320 Executive Dr Suite 214 Raleigh NC 27609-7445 |
| Practice Telephone | 9198788596 |
| Enumeration Date | 2015-11-24 |
| Last Update Date | 2015-11-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0010-06072 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3320 EXECUTIVE DR SUITE 214 |
| City | RALEIGH |
| State | NC |
| Zip Code | 27609-7445 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265438816 | Lori Walker Couch | Optometrist | 3320 Executive Dr, Suite 111, Raleigh, NC 27609-7445 | 2005-06-27 |
| 1689912792 | Metro Internal Medicine P.a. | Clinic/Center | 3320 Executive Dr, Ste. 222, Raleigh, NC 27609-7445 | 2013-01-24 |
| 1922390913 | Orthopaedic Specialists of North Carolina, P.a. | Orthopaedic Surgery | 3320 Executive Dr, Suite 218, Raleigh, NC 27609-7445 | 2011-05-09 |
| 1396047536 | Tanya Ann Mariie Meikle | Physical Therapist | 3320 Executive Dr, Suite 210, Raleigh, NC 27609-7445 | 2010-11-19 |
| 1609005461 | Anita Prakash Vin-parikh | Ophthalmology | 3320 Executive Dr, Raleigh, NC 27609-7445 | 2009-07-14 |
| 1891929618 | James Anthony Wrzosek | Internal Medicine | 3320 Executive Dr, Suite 111, Raleigh, NC 27609-7445 | 2009-05-07 |
| 1093831570 | Pamela J. Whitney, M.d, P.a. | Specialist | 3320 Executive Dr, Suite 218, Raleigh, NC 27609-7445 | 2007-03-22 |
| 1881724334 | Assad Meymandi | Specialist | 3320 Executive Dr, Suite 218, Raleigh, NC 27609-7445 | 2007-03-06 |
| 1336276427 | Alice Angela Lin | Ophthalmology | 3320 Executive Dr, Suite 111, Raleigh, NC 27609-7445 | 2007-02-27 |
| 1255471181 | Jerome J Magolan Jr. | Specialist | 3320 Executive Dr, Ste 111, Raleigh, NC 27609-7445 | 2007-02-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184235582 | Choice Service Solutions LLC | In Home Supportive Care | 5300 Six Fox Rd Siite205, Raleigh, NC 27609 | 2020-08-11 |
| 1003426073 | Rosana Oba -rovira | Registered Nurse | 5300 Six Fox Road, Suite 205, Raleigh, NC 27609 | 2020-08-05 |
| 1821612706 | Helen Alexandra Bonner | Physical Medicine & Rehabilitation | Hey Clinic Pa, 3320 Wake Forest Road Ste 450, Raleigh, NC 27609 | 2020-06-05 |
| 1215423579 | Appiah Nana Larbi | Social Worker | Easter Seals Ucp 4000 Wake Forest Rd Ste 200, Raleigh, NC 27609 | 2018-07-10 |
| 1215423777 | Broadway Home Care LLC | In Home Supportive Care | 107 Windel Dr Ste 105, Raleigh, NC 27609 | 2018-07-09 |
| 1275027948 | Lacey Allene Cottingham | Social Worker | 312 W Millbrook Rd Ste 129, Raleigh, NC 27609 | 2018-06-18 |
| 1447748819 | Integrated Dermatology of North Raleigh, Pllc | Dermatology | 3809 Computer Dr Ste 200, Raleigh, NC 27609 | 2018-05-01 |
| 1902325418 | Naomi Christine Askew | Nurse Practitioner | 3400 Wake Forest Drive, Bldg 9, Bldg #9, 4th Floor, Raleigh, NC 27609 | 2017-09-15 |
| 1962929679 | Alexia Montague | Social Worker | 1306 Paddock Drive Suite E-100, Raleigh, NC 27609 | 2017-08-23 |
| 1730602236 | Chantel Washington-mbuthia | Counselor | 1100 Logger Ct. Ste C100, Heartfelt Alternative Inc, Raleigh, NC 27609 | 2017-07-18 |
| Find all providers in zip 27609 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457961682 | Megan Kathleen Brown | Physician Assistant | 3024 New Bern Ave Ste 102, Raleigh, NC 27610-1247 | 2020-08-03 |
| 1124640651 | Kayla Marie Sincock | Physician Assistant | 12205 Harcourt Dr, Raleigh, NC 27613-5603 | 2020-05-06 |
| 1093340531 | Hannah Stanifer | Physician Assistant | 510 N Wilmington St Apt 227, Raleigh, NC 27604-8021 | 2020-03-05 |
| 1962035642 | Brianna Stolz | Physician Assistant | 3811 Ed Dr Ste 110, Raleigh, NC 27612-2393 | 2020-02-20 |
| 1316577737 | Jacey Elizabeth Byers | Physician Assistant | 700 Hawes Ct Apt C, Raleigh, NC 27608-1745 | 2020-01-24 |
| 1033756598 | Julie A Romeis | Physician Assistant | 1929 N Hills Dr Unit G, Raleigh, NC 27612-4022 | 2019-12-04 |
| 1346886769 | Pooja Parmar | Physician Assistant | 8804 Bluff Pointe Ct, Raleigh, NC 27615-4172 | 2019-11-20 |
| 1649829557 | Bryan Edwards | Physician Assistant | 4551 New Bern Ave Ste A100, Raleigh, NC 27610-1551 | 2019-09-04 |
| 1790343192 | Savanah Palen Mullen | Physician Assistant | 10208 Cerny St Ste 204, Raleigh, NC 27617-7885 | 2019-05-31 |
| 1356906184 | Andrew Paul Apicella | Physician Assistant | 3024 New Bern Ave Ste 302, Raleigh, NC 27610-1247 | 2019-05-07 |
| Find all providers in RALEIGH | ||||
Please comment or provide details below to improve the information on MALLORY LAKE.
| 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.