Provider Demographics
NPI:1033448469
Name:MOLLOY, EILEEN MARIE (MS, RDN CDE)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MARIE
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:MS, RDN CDE
Other - Prefix:
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Mailing Address - Street 1:16 LIMEROCK ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-2117
Mailing Address - Country:US
Mailing Address - Phone:207-236-0678
Mailing Address - Fax:207-921-3990
Practice Address - Street 1:6 GLEN COVE DR
Practice Address - Street 2:PEN BAY MEDICAL CENTER
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4240
Practice Address - Country:US
Practice Address - Phone:207-596-8537
Practice Address - Fax:207-921-3990
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEDI344133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMT0189Medicare PIN