Provider Demographics
NPI:1902163694
Name:FENG, MALLORY (MD)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:
Last Name:FENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-4300
Mailing Address - Country:US
Mailing Address - Phone:617-302-6096
Mailing Address - Fax:
Practice Address - Street 1:955 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-4300
Practice Address - Country:US
Practice Address - Phone:617-302-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2950232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry