Provider Demographics
NPI:1508486465
Name:MALL, JENNIFER KATHLEEN (MD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KATHLEEN
Last Name:MALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9104 BABCOCK BLVD STE 6000
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5818
Mailing Address - Country:US
Mailing Address - Phone:412-358-9613
Mailing Address - Fax:412-358-9619
Practice Address - Street 1:9104 BABCOCK BLVD STE 6000
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5818
Practice Address - Country:US
Practice Address - Phone:412-358-9613
Practice Address - Fax:412-358-9619
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD482307207Q00000X
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program