Provider Demographics
NPI:1528387487
Name:MOLONEY, BRYAN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:CHRISTOPHER
Last Name:MOLONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-5695
Mailing Address - Fax:419-383-3183
Practice Address - Street 1:1400 E MEDICAL LOOP
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8004
Practice Address - Country:US
Practice Address - Phone:419-383-5695
Practice Address - Fax:419-383-3183
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.1206592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0095466Medicaid