Provider Demographics
NPI:1073577375
Name:MOLLE, JEFFREY S (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:MOLLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9275 MEDICAL PLAZA DR STE F
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9140
Mailing Address - Country:US
Mailing Address - Phone:803-767-4465
Mailing Address - Fax:803-767-4120
Practice Address - Street 1:176 MCSWAIN DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4825
Practice Address - Country:US
Practice Address - Phone:803-767-4465
Practice Address - Fax:803-767-4120
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200901168208600000X
VA0101052466208600000X
SC84100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN0116EMedicaid
VA010083401Medicaid
VA010083401Medicaid