MALLORY FOSSA


Address: 282 Washington St, Hartford, CT 06106-3322
Phone: 8608375207

MALLORY FOSSA (NPI# 1780059030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1780059030
Entity Type Individual
Full Name MALLORY FOSSA
Credential PNP-PC
Practice Address 282 Washington St
Hartford
CT 06106-3322
Mailing Address 3701 Wilshire Blvd
Suite 600
Los Angeles
CA 90010-2814
Practice Telephone 8608375207
Mailing Telephone 3233613550
Mailing Fax Number 3233618502
Enumeration Date 2015-12-10
Last Update Date 2019-07-12
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363LP0200X Nurse Practitioner
Specialization: Pediatrics
12.008276 CT Physician Assistants & Advanced Practice Nursing Providers
N 363LP0200X Nurse Practitioner
Specialization: Pediatrics
95003548 CA Physician Assistants & Advanced Practice Nursing Providers
Y 207LP3000X Anesthesiology
Specialization: Pediatric Anesthesiology
95003548 CA Allopathic & Osteopathic Physicians

Provider Secondary Practice Location

Address Telephone Number Fax Number
4650 W Sunset Blvd, Ms #12; 4th Floor Mcallister Building, Los Angeles, CA 900276062 3233617686

Office Location

Street Address 282 WASHINGTON ST
City HARTFORD
State CT
Zip Code 06106-3322

Providers in the same location

NPI Name Taxonomy Address Enumeration
1215925037 Jeffrey S Hyams Pediatrics 282 Washington St, Hartford, CT 06106-3322 2005-10-06
1902411127 Rebecca Katherine Benjamin Registered Nurse 282 Washington St, Hartford, CT 06106-3322 2020-09-14
1457960486 Jillian Scott Registered Nurse 282 Washington St, Hartford, CT 06106-3322 2020-07-27
1962029660 Brittany Athena Molkenthin Registered Nurse 282 Washington St, Hartford, CT 06106-3322 2020-06-29
1295358794 Michaela Kathleen Rotondi Nurse Practitioner 282 Washington St, Hartford, CT 06106-3322 2020-05-19
1881216067 Loida Montanez Pharmacist 282 Washington St, Hartford, CT 06106-3322 2020-05-11
1215558853 Elizabeth Lachat Social Worker 282 Washington St, Hartford, CT 06106-3322 2020-05-06
1023638848 Evan Fusaro Physician Assistant 282 Washington St, Hartford, CT 06106-3322 2020-04-22
1992325062 Lusine Unanyan Student in an Organized Health Care Education/Training Program 282 Washington St, Hartford, CT 06106-3322 2020-04-19
1518586577 Patrick James Gallaway Student in an Organized Health Care Education/Training Program 282 Washington St, Hartford, CT 06106-3322 2020-04-10
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1750907325 Vartika Kesarwani Student in an Organized Health Care Education/Training Program Hartford Hospital Adult Primary Care-brown Stone, 79 Retreat Avenue, Hartford, CT 06106 2020-06-19
1720602865 Meher Kaur Singha Student in an Organized Health Care Education/Training Program Hartford Hospital Adult Primary Care- Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 2020-06-04
1497314140 Eduardo Mantovani Cardoso Student in an Organized Health Care Education/Training Program Hartford Hospital Adut Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 2019-06-06
1114582178 Dimitrios Drekolias Student in an Organized Health Care Education/Training Program Hartford Hospital Adult Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 2019-05-06
1316501687 Rafae Shaikh Student in an Organized Health Care Education/Training Program Hartford Hospital Adult Primary Care Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 2019-04-23
1437643715 Lucas Bensa Social Worker 421 Washington St., Apt C1, Hartford, CT 06106 2018-06-19
1548754310 Collin Dimler Physician Assistant 85 Seymour St Ste 1003, Hartford, CT 06106 2018-06-15
1619460581 Bryan F Stringer Student in an Organized Health Care Education/Training Program 79 Retreat Ave., Hh-adult Primary Care - Brown Stone, Hartford, CT 06106 2018-06-14
1083103972 Margret Sigurdardottir Blondal Student in an Organized Health Care Education/Training Program 282 Washington Street, Ste 4h, Hartford, CT 06106 2018-05-07
1265920995 Rudra Ramanathan Student in an Organized Health Care Education/Training Program 79 Retreat Ave Brown Stone, Hartford, CT 06106 2018-04-27
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Taxonomy Information

Taxonomy Code 207LP3000X
Grouping Allopathic & Osteopathic Physicians
Classification Anesthesiology
Specialization Pediatric Anesthesiology

Taxonomy Definition

An anesthesiologist who has had additional skill and experience in and is primarily concerned with the anesthesia, sedation, and pain management needs of infants and children. A pediatric anesthesiologist generally provides services including the evaluation of complex medical problems in infants and children when surgery is necessary, planning and care for children before and after surgery, pain control, anesthesia and sedation for any procedures out of the operating room such as MRI, CT scan, and radiation therapy.
Notes: Source: American Academy of Pediatrics, www.aap.org [7/1/2006: new]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1366868168 Mary G Ruddat Anesthesiology 69 Sunny Reach Dr, West Hartford, CT 06117-1531 2014-03-17
1376939306 Matthieu Newton Anesthesiology 20 York St, New Haven, CT 06510-3220 2015-04-07
1083697445 Cheryl K Gooden Anesthesiology 20 York St, New Haven, CT 06510-3220 2005-11-21

Competitor

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City HARTFORD
Zip Code 06106

Improve Information

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Dataset Information

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.

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