Mallory Fossa, PNP-PC is a medicare enrolled "Anesthesiology - Pediatric Anesthesiology" in Hartford, Connecticut. Her current practice location is
282 Washington St, Hartford, Connecticut. You can reach out to her office (for appointments etc.) via phone at
(860) 837-5207.
Mallory Fossa is licensed to practice in California (license number 95003548) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1780059030.
Provider's Profile
| Full Name | Mallory Fossa |
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| Gender | Female |
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| Speciality | |
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| Experience | Years |
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| Location | 282 Washington St, Hartford, Connecticut |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mallory Fossa attended and graduated from in
NPI Data:
- NPI Number: 1780059030
- Provider Enumeration Date: 12/10/2015
- Last Update Date: 09/12/2022
Medicare PECOS Information:
- PECOS PAC ID:
- Enrollment ID:
Medical Identifiers
Medical identifiers for Mallory Fossa such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1780059030 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LP0200X | Nurse Practitioner - Pediatrics | 95003548 (California) | Secondary |
| 363LP0200X | Nurse Practitioner - Pediatrics | 12.008276 (Connecticut) | Secondary |
| 207LP3000X | Anesthesiology - Pediatric Anesthesiology | 95003548 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mallory Fossa is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mallory Fossa, PNP-PC
3701 Wilshire Blvd, Suite 600,
Los Angeles, CA 90010-2814
Ph: (323) 361-3550 | Mallory Fossa, PNP-PC
282 Washington St,
Hartford, CT 06106-3322
Ph: (860) 837-5207 |
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