Provider Demographics
NPI:1366454076
Name:MALLICK, RAJANI K (MD)
Entity Type:Individual
Prefix:
First Name:RAJANI
Middle Name:K
Last Name:MALLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 TAUNTON AVE
Mailing Address - Street 2:P O BOX BJ
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2707
Mailing Address - Country:US
Mailing Address - Phone:508-285-9500
Mailing Address - Fax:508-285-3388
Practice Address - Street 1:14 TAUNTON AVE
Practice Address - Street 2:P O BOX BJ
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2707
Practice Address - Country:US
Practice Address - Phone:508-285-9500
Practice Address - Fax:508-285-3388
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRM086755207Q00000X
MA246529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088793AMedicaid
MAAA210168OtherHPHC
MA764328OtherTUFTS
MAJ48474OtherBCBS MA
MII41441Medicare UPIN
MA110088793AMedicaid