Provider Demographics
NPI:1093778631
Name:MALLARI, IRENEA C (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENEA
Middle Name:C
Last Name:MALLARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO 552106
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33655-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2010 59TH ST W
Practice Address - Street 2:STE 5600
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4686
Practice Address - Country:US
Practice Address - Phone:941-798-3524
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME21824207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D58034Medicare UPIN
71330Medicare ID - Type Unspecified