Basic Information
| Provider Information | |||||||||
| NPI: | 1295732287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLLOV | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 PRIMROSE ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | HAVERHILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018302659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785561000 | ||||||||
| FaxNumber: | 9785560094 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 PRIMROSE ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | HAVERHILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018302659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785561000 | ||||||||
| FaxNumber: | 9785560100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 42450 | MA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2064057 | 05 | MA | MEDICAID |