Healthcare Provider Details

I. General information

NPI: 1639639859
Provider Name (Legal Business Name): ALLISON M. MOLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON M. COOL

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 WILKENS AVE STE 100
BALTIMORE MD
21229-4899
US

IV. Provider business mailing address

81 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

V. Phone/Fax

Practice location:
  • Phone: 410-247-0782
  • Fax:
Mailing address:
  • Phone: 801-662-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD94665
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11912736-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: