Provider Demographics
NPI:1629188966
Name:MALLICK, SANGITA K (MD)
Entity type:Individual
Prefix:
First Name:SANGITA
Middle Name:K
Last Name:MALLICK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:186 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4436
Mailing Address - Country:US
Mailing Address - Phone:781-861-0890
Mailing Address - Fax:781-861-0899
Practice Address - Street 1:95 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1524
Practice Address - Country:US
Practice Address - Phone:781-581-4400
Practice Address - Fax:781-592-0581
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2307542084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry