Provider Demographics
NPI:1629319512
Name:MOLLO, KATHERINE E (DO)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:MOLLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 LONGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8550
Mailing Address - Country:US
Mailing Address - Phone:803-788-0577
Mailing Address - Fax:803-788-5760
Practice Address - Street 1:237 LONGTOWN RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8550
Practice Address - Country:US
Practice Address - Phone:803-404-5638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-03
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC367202080H0002X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine