Provider Demographics
NPI:1386972040
Name:MOLL, JEFFREY MICHAEL (M D)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:MOLL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MARBLE RD
Mailing Address - Street 2:
Mailing Address - City:MARBLE
Mailing Address - State:PA
Mailing Address - Zip Code:16334-0098
Mailing Address - Country:US
Mailing Address - Phone:814-354-2231
Mailing Address - Fax:
Practice Address - Street 1:110 MARBLE RD
Practice Address - Street 2:
Practice Address - City:MARBLE
Practice Address - State:PA
Practice Address - Zip Code:16334-0098
Practice Address - Country:US
Practice Address - Phone:814-354-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4343502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry