Provider Demographics
NPI:1639144751
Name:MOLLIGAN, HARRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:J
Last Name:MOLLIGAN
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 1:600 GRESHAM DR
Mailing Address - Street 2:STE 204
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-5680
Mailing Address - Fax:757-388-5681
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:STE 204
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-5680
Practice Address - Fax:757-388-5681
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041146207X00000X
NC2016-01367207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006408761Medicaid
VA006408761Medicaid
E09930Medicare UPIN