Provider Demographics
NPI:1275129678
Name:MALLOY, DAVID JOSEPH
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:MALLOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-7544
Mailing Address - Country:US
Mailing Address - Phone:513-383-2088
Mailing Address - Fax:
Practice Address - Street 1:42 ARCADIA PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-2802
Practice Address - Country:US
Practice Address - Phone:513-373-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker