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NPI Code Detail

MEDICARE: MOLLIE WIDDOWSON

MEDICARE: MOLLIE WIDDOWSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker19302MD

General Provider Information

NPI Number : 1548618598
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLIE WIDDOWSON
Provider Business Mailing Address
First Line : 11670 OLD NATIONAL PIKE
Second Line : 103
City : NEW MARKET
State : MD
Zip : 21774-6123
Country : US
Telephone Number : 301-865-2226
Fax Number : 301-865-6720
Provider Business Practice Location Address
First Line : 11670 OLD NATIONAL PIKE
Second Line : 103
City : NEW MARKET
State : MD
Zip : 21774-6123
Country : US
Telephone Number : 301-865-2226
Fax Number : 301-865-6720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2016
Last Update Date : 06/01/2016

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