Provider Demographics
NPI:1346725157
Name:MOLLISON, SCOTT WILLIAM NIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLIAM NIEL
Last Name:MOLLISON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22567 SUMMIT DR BLDG II
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-7210
Mailing Address - Country:US
Mailing Address - Phone:315-779-6784
Mailing Address - Fax:315-779-6799
Practice Address - Street 1:22567 SUMMIT DR BLDG 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-7210
Practice Address - Country:US
Practice Address - Phone:315-779-6784
Practice Address - Fax:315-779-6799
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2021-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY294894207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY294894OtherMEDICAL LICENSE