Provider Demographics
NPI:1265893127
Name:UCCHINO, MALLORY ANN (DO)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:ANN
Last Name:UCCHINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9471 MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-8702
Mailing Address - Country:US
Mailing Address - Phone:330-726-7100
Mailing Address - Fax:330-758-0347
Practice Address - Street 1:9471 MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:NORTH LIMA
Practice Address - State:OH
Practice Address - Zip Code:44452-8702
Practice Address - Country:US
Practice Address - Phone:330-726-7100
Practice Address - Fax:330-758-0347
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013109CTR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine