Healthcare Provider Details

I. General information

NPI: 1376579409
Provider Name (Legal Business Name): PLANET RHEUMATOLOGY,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 RESNIK RD
PLYMOUTH MA
02360-4844
US

IV. Provider business mailing address

45 RESNIK RD
PLYMOUTH MA
02360-4896
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 Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP J MOLLOY IV
Title or Position: DIRECTOR/PRESIDENT
Credential: MD
Phone: 508-746-5351