Provider Demographics
NPI:1083677736
Name:HALL, MOLLY J (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-8305
Mailing Address - Fax:937-208-6286
Practice Address - Street 1:2222 PHILADELPHIA DR
Practice Address - Street 2:SUITE 4505
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1813
Practice Address - Country:US
Practice Address - Phone:937-734-4363
Practice Address - Fax:937-734-4181
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 0641502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0090661Medicaid
OH0090661Medicaid