Provider Demographics
NPI:1588659577
Name:MOLLIN, DANIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:MOLLIN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3100 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8036
Mailing Address - Country:US
Mailing Address - Phone:919-781-7500
Mailing Address - Fax:919-645-3054
Practice Address - Street 1:3100 BLUE RIDGE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8036
Practice Address - Country:US
Practice Address - Phone:919-781-7500
Practice Address - Fax:919-645-3054
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2012-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9600797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8959989Medicaid
NC8959989Medicaid
NCG28796Medicare UPIN