Healthcare Provider Details

I. General information

NPI: 1114125903
Provider Name (Legal Business Name): MOLLY E. MENTZER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 DEGRANDPRE WAY
PLATTSBURGH NY
12901-6449
US

IV. Provider business mailing address

17 WILDFLOWER LN
MORRISONVILLE NY
12962-3016
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-3260
  • Fax: 518-561-2877
Mailing address:
  • Phone: 484-565-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number275860-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: