ASHOK R MALLYA (NPI# 1104873116) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104873116 |
Entity Type | Individual |
Full Name | ASHOK R MALLYA |
Credential | MD |
Practice Address |
915 N Grand Blvd Saint Louis MO 63106-1621 |
Mailing Address |
12515 Windmoor Pl Saint Louis MO 63131-3019 |
Practice Telephone | 3146524100 |
Mailing Telephone | 3146524100 |
Enumeration Date | 2006-05-27 |
Last Update Date | 2007-07-08 |
Gender Code | M |
Is Sole Proprietor | X |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
R6991 | MO | Allopathic & Osteopathic Physicians |
Street Address |
915 N GRAND BLVD |
City | SAINT LOUIS |
State | MO |
Zip Code | 63106-1621 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1033115480 | Jamie Lynn Swanson | Physician Assistant | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2005-06-21 |
1821602756 | Courtney Kay Duberry | Optometrist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-09-08 |
1043820053 | Kathryn Marie Storm | Pharmacist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-08-04 |
1326657230 | Rebecca Oluwafunmito Babalola | Pharmacist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-07-27 |
1639787328 | Justin Clarke Liedke | Pharmacist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-07-19 |
1639796899 | Taylor Anderson | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-07-02 |
1427675800 | Lauren Elizabeth Smith | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-07-01 |
1427675925 | Christa Marie Stoutenborough | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-06-30 |
1992322739 | Alexia Lambos Georges | Perfusionist | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-06-27 |
1912522210 | Meaghan Elizabeth Lecture | Nurse Practitioner | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2020-06-11 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1770027997 | Superior Manor of Downtown LLC | Assisted Living Facility | 1501 Clinton St., St Louis, MO 63106 | 2016-12-07 |
1811361454 | James Preston Jr. | Pharmacist | 915 N. Grand Vlvd, Pharmacy Dept., John Cochran Va Medical Center, Saint Louis, MO 63106 | 2015-11-19 |
1245656354 | Julie Marie Albsmeyer | Physician Assistant | 915 North Grand 111-jc-gi, John Cochran Va Hospital, St. Louis, MO 63106 | 2014-03-13 |
1932523230 | Cathy Yeung | Registered Nurse | 715 N Grand Blvd., St Louis, MO 63106 | 2014-02-07 |
1902149388 | Amanda Foley | Doula | 4056 Humphrey Street, Saint Louis, MO 63106 | 2013-04-03 |
1942569876 | Cornelia Charles | Internal Medicine | 915 Norh Grand Blvd, Saint Louis, MO 63106 | 2012-05-12 |
1124334396 | Kasandra Ann Tinajero | Registered Nurse | 915 N. Grand Blvd., St. Louis, MO 63106 | 2010-08-26 |
1366673931 | Cassandra Vernetta Talbert | Social Worker | 915 N. Grand., 122/jc Social Work Dept. V.a. Medical Center, St. Louis, MO 63106 | 2009-07-30 |
1497910707 | Robert Louis Tillman | Pharmacy Technician | 915 N Grand Ave, St. Louis, MO 63106 | 2008-07-25 |
1861676686 | Bradley Dean Overmeyer | Social Worker | 915 N Grand Blvd., Social Work Service, St. Louis, MO 63106 | 2007-12-28 |
Find all providers in zip 63106 |
Taxonomy Code | 2084A0401X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Addiction Medicine |
A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982928065 | Jack L. Croughan Inc | Psychiatry & Neurology | 1034 S Brentwood Blvd, Suite 970, Saint Louis, MO 63117-1223 | 2010-03-18 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1760559181 | Thomas James Breidenstein | Psychiatry & Neurology | 108 E Green Meadows Rd, Suite 8, Columbia, MO 65203-3633 | 2006-11-29 |
1235203308 | David Edward Sternberg | Psychiatry & Neurology | 527 Sw Market St, Lees Summit, MO 64063-3918 | 2006-11-20 |
1689661829 | Subbu Joseph Sarma | Psychiatry & Neurology | 4025 Ne Lakewood Way Ste 210, Lees Summit, MO 64064-2059 | 2005-10-03 |
1962819326 | Oluwole Popoola | Psychiatry & Neurology | One Hospital Dr, Columbia, MO 65212 | 2014-07-17 |
1588659288 | David Lee Ohlms | Psychiatry & Neurology | 12166 Old Big Bend Rd, Suite 100, Kirkwood, MO 63122-6844 | 2005-09-19 |
City | SAINT LOUIS |
Zip Code | 63106 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.