Healthcare Provider Details

I. General information

NPI: 1659513992
Provider Name (Legal Business Name): ABDOLGHADER MOLAVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 GRASON LANE
BAR HARBOR ME
04609
US

IV. Provider business mailing address

19 GRASON LANE
BAR HARBOR ME
04609
US

V. Phone/Fax

Practice location:
  • Phone: 207-669-4966
  • Fax:
Mailing address:
  • Phone: 207-669-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD024597E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD024597E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: