Provider Demographics
NPI:1992743579
Name:MAGNANO, MOLLY DETGEN (MD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:DETGEN
Last Name:MAGNANO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2850 TELEGRAPH AVE
Mailing Address - Street 2:120
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1192
Mailing Address - Country:US
Mailing Address - Phone:510-204-8120
Mailing Address - Fax:510-649-1238
Practice Address - Street 1:2850 TELEGRAPH AVE
Practice Address - Street 2:120
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1192
Practice Address - Country:US
Practice Address - Phone:510-204-8120
Practice Address - Fax:510-649-1238
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA80346207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI56934Medicare UPIN