DR. MALLERY OLSEN MD NPI 1649664871

NPI Information

  • NPI: 1649664871
  • Provider Name: DR. MALLERY OLSEN, MD
  • Classification: Pediatrics - 2080P0207X
  • Specialization: Pediatric Hematology-Oncology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2450 RIVERSIDE AVE
    MINNEAPOLIS, MN
    ZIP 55454
  • Phone: (612) 365-8100

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NPI Details

DR. Mallery Olsen, MD is a pediatric hematology-oncology pediatrics in Minneapolis, MN with 11 years of experience. The provider is a pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases. DR. Mallery Olsen, MD NPI is 1649664871. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2450 RIVERSIDE AVE
MINNEAPOLIS, MN
ZIP 55454-450
Phone: (612) 365-8100

The NPI 1649664871 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/25/2015 and was last updated on 10/24/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12080P0207XPediatricsPediatric Hematology-Oncology80064MINNESOTAYes
2208D00000XGeneral Practice80064MINNESOTANo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1163982MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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