Provider Demographics
NPI:1013964758
Name:MALLARI, SEAN ALAN (MD)
Entity type:Individual
Prefix:
First Name:SEAN ALAN
Middle Name:
Last Name:MALLARI
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 1:52 HILLSDALE ST
Mailing Address - Street 2:# 1
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5716
Mailing Address - Country:US
Mailing Address - Phone:617-298-5399
Mailing Address - Fax:
Practice Address - Street 1:52 HILLSIDE ST
Practice Address - Street 2:#1
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-3348
Practice Address - Country:US
Practice Address - Phone:617-298-5399
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA818852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry