Provider Demographics
NPI:1427059153
Name:EZZIE, MOLLIE K (MD)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:K
Last Name:EZZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:750 MOUNT CARMEL MALL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1553
Mailing Address - Country:US
Mailing Address - Phone:614-434-2400
Mailing Address - Fax:614-434-2499
Practice Address - Street 1:750 MOUNT CARMEL MALL
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1553
Practice Address - Country:US
Practice Address - Phone:614-434-2400
Practice Address - Fax:614-434-2499
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-083854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI34442Medicare UPIN
OHEZ4163562Medicare ID - Type Unspecified4300 CLIME RD
OHEZ4163561Medicare ID - Type Unspecified750 MT CARMEL MAA