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General NPI Number Information
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NPI Number | 1396975009
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Entity Type | Individual
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Provider Name | ELLEN CHASE VAN MOL M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 1000 N OLIVE AVE
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3512
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Country | US
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Telephone | 561-557-1767
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Fax | 561-327-5125
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Provider Business Mailing Address
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Address Line | 9914 EQUUS CIRCLE
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City | BOYNTON BEACH
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State | FL
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Zip | 60611-5359
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Country | US
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Telephone | 706-296-6555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME112566
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License Number State | FL
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