Healthcare Provider Details

I. General information

NPI: 1205415809
Provider Name (Legal Business Name): VAELAN MOLIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST
RICHMOND VA
23298-5023
US

IV. Provider business mailing address

2510 RIDGETOP RD
AMES IA
50014-4563
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9165
  • Fax:
Mailing address:
  • Phone: 515-520-0298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number207T00000X
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: