Provider Demographics
NPI:1558377648
Name:MALLOZZI, MARINO D (MD)
Entity Type:Individual
Prefix:
First Name:MARINO
Middle Name:D
Last Name:MALLOZZI
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-733-6546
Mailing Address - Fax:717-733-6011
Practice Address - Street 1:446 N READING RD
Practice Address - Street 2:SUITE 301
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9802
Practice Address - Country:US
Practice Address - Phone:717-733-6546
Practice Address - Fax:717-733-6010
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056528L208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00269502OtherRAILROAD MEDICARE
PA0015302170001Medicaid
PA783382OtherBLUE SHIELD
PAG05189Medicare UPIN
PAG05189Medicare UPIN