Provider Demographics
NPI:1598262362
Name:MOLL, RYAN DUSTIN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DUSTIN
Last Name:MOLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 FEDERAL ST STE B300
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4775
Mailing Address - Country:US
Mailing Address - Phone:412-359-3751
Mailing Address - Fax:
Practice Address - Street 1:1307 FEDERAL ST STE B300
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4775
Practice Address - Country:US
Practice Address - Phone:412-359-3751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021401207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine