Provider Demographics
NPI:1871646810
Name:MALLYA, ULLAL L (MD)
Entity Type:Individual
Prefix:
First Name:ULLAL
Middle Name:L
Last Name:MALLYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14193 DAY FARM RD
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737-9515
Mailing Address - Country:US
Mailing Address - Phone:410-489-4882
Mailing Address - Fax:410-871-6808
Practice Address - Street 1:14193 DAY FARM RD
Practice Address - Street 2:
Practice Address - City:GLENELG
Practice Address - State:MD
Practice Address - Zip Code:21737-9515
Practice Address - Country:US
Practice Address - Phone:410-489-4882
Practice Address - Fax:410-871-6808
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00162472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry