Provider Demographics
NPI:1972731115
Name:BALMER-SWAIN, MALLORY ANNE (DO)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:ANNE
Last Name:BALMER-SWAIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MALLORY
Other - Middle Name:ANNE
Other - Last Name:BALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1425 PORTLAND AVE
Mailing Address - Street 2:SANDS CONSTELLATION HEART INSTITUTE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3022
Mailing Address - Country:US
Mailing Address - Phone:585-442-5320
Mailing Address - Fax:585-442-5526
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:SANDS CONSTELLATION HEART INSTITUTE
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3022
Practice Address - Country:US
Practice Address - Phone:585-442-5320
Practice Address - Fax:585-442-5526
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278446207RC0000X
TXP1446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400225546Medicare PIN
NYJ400225547Medicare PIN