MALLORY FOSSA (NPI# 1780059030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
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 |
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 |
Address | Telephone Number | Fax Number |
---|---|---|
4650 W Sunset Blvd, Ms #12; 4th Floor Mcallister Building, Los Angeles, CA 900276062 | 3233617686 |
Street Address |
282 WASHINGTON ST |
City | HARTFORD |
State | CT |
Zip Code | 06106-3322 |
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 |
Find all providers in the same location |
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 |
Find all providers in zip 06106 |
Taxonomy Code | 207LP3000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Anesthesiology |
Specialization | Pediatric Anesthesiology |
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] |
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 |
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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.