Provider Demographics
NPI:1649377680
Name:MALLOY, BERNARD MOTHIS (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:MOTHIS
Last Name:MALLOY
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 1:3 WASHINGTON CIRCLE NW
Mailing Address - Street 2:#403
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-333-6483
Mailing Address - Fax:202-333-6483
Practice Address - Street 1:3 WASHINGTON CIRCLE NW
Practice Address - Street 2:#403
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-333-6483
Practice Address - Fax:202-333-6483
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD251092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C61530Medicare UPIN
MA023670Medicare ID - Type Unspecified