Provider Demographics
NPI:1235528738
Name:WARD, MALLORY K (MS-PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:K
Last Name:WARD
Suffix:
Gender:F
Credentials:MS-PA-C
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Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5782
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:85 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-857-8623
Practice Address - Fax:716-250-5907
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2018-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY018385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant