Provider Demographics
NPI:1154397685
Name:HARLING, MALLORY T (MD)
Entity type:Individual
Prefix:MR
First Name:MALLORY
Middle Name:T
Last Name:HARLING
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 1:1450 E VALLEY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8352
Mailing Address - Country:US
Mailing Address - Phone:970-927-1717
Mailing Address - Fax:970-927-6164
Practice Address - Street 1:1450 E VALLEY RD STE 105
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8352
Practice Address - Country:US
Practice Address - Phone:970-927-1717
Practice Address - Fax:970-927-6164
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16141207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609842145OtherGROUP NPI
201467647OtherTAX ID
CO01161413Medicaid
CO01161413Medicaid
1609842145OtherGROUP NPI