Provider Demographics
NPI:1558302612
Name:ROBERTS, MOLLY MANNING (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:MANNING
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD, MS
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Mailing Address - Street 1:2443 FILLMORE ST # 380-3991
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1814
Mailing Address - Country:US
Mailing Address - Phone:415-964-0546
Mailing Address - Fax:888-861-2143
Practice Address - Street 1:2443 FILLMORE ST # 380-3991
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1814
Practice Address - Country:US
Practice Address - Phone:415-964-0546
Practice Address - Fax:888-861-2143
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ30042207Q00000X
CAC53951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI01764Medicare UPIN