Provider Demographics
NPI:1427037951
Name:MALLEN, JOHN KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENNETH
Last Name:MALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 STILES RD
Mailing Address - Street 2:STE 204
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079
Mailing Address - Country:US
Mailing Address - Phone:603-894-9898
Mailing Address - Fax:603-894-6270
Practice Address - Street 1:32 STILES RD
Practice Address - Street 2:STE 204
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-894-9898
Practice Address - Fax:603-894-6270
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10052208200000X
MA154434208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0103459Y0NH01OtherBC
21296OtherHARVARD
29841OtherFALLON
07571390OtherCIGNA
154434OtherTUFTS
MAJIF258OtherBC
154434OtherTUFTS
MAJIF258OtherBC
NH0103459Y0NH01OtherBC