Healthcare Provider Details

I. General information

NPI: 1710927074
Provider Name (Legal Business Name): ROBERT JOSEPH MOLLE C.R.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 DEFENSE HWY SUITE 400
ANNAPOLIS MD
21401-7027
US

IV. Provider business mailing address

116 DEFENSE HWY SUITE 400
ANNAPOLIS MD
21401-7027
US

V. Phone/Fax

Practice location:
  • Phone: 410-897-9841
  • Fax: 410-897-9852
Mailing address:
  • Phone: 410-897-9841
  • Fax: 410-897-9852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR132683
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: