1295875409 NPI number — DR. MARY JOAN FROST MOLLE M.D.

Table of content: DR. MARY JOAN FROST MOLLE M.D. (NPI 1295875409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295875409 NPI number — DR. MARY JOAN FROST MOLLE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FROST MOLLE
Provider First Name:
MARY
Provider Middle Name:
JOAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FROST
Provider Other First Name:
MARY
Provider Other Middle Name:
JOAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1295875409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10237 BRADLEY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-3907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-884-3457
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7180 COLUMBIA GATEWAY DR
Provider Second Line Business Practice Location Address:
HOWARD COUHTY HEALTH DEPT.
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21046-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-313-7500
Provider Business Practice Location Address Fax Number:
410-313-7502
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D0051182 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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