Healthcare Provider Details

I. General information

NPI: 1730227752
Provider Name (Legal Business Name): DANIEL JOSEPH MOLLURA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

243 SYCAMORE RIDGE RD
LAUREL MD
20724-2954
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-6500
  • Fax:
Mailing address:
  • Phone: 301-604-8076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberT0786
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: