Healthcare Provider Details

I. General information

NPI: 1205829793
Provider Name (Legal Business Name): PHILIP JOSEPH MOLLOY IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 RESNIK RD SUITE 203
PLYMOUTH MA
02360
US

IV. Provider business mailing address

45 RESNIK RD SUITE 203
PLYMOUTH MA
02360
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-5351
  • Fax: 508-747-3299
Mailing address:
  • Phone: 508-746-5351
  • Fax: 508-747-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number52498
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: