Provider Demographics
NPI:1700863545
Name:WARE, MOLLY GLEN (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:GLEN
Last Name:WARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5450 WESTERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-442-2395
Mailing Address - Fax:303-442-1073
Practice Address - Street 1:4743 ARAPAHOE AVE STE 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1128
Practice Address - Country:US
Practice Address - Phone:303-442-2395
Practice Address - Fax:303-442-1073
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR-46218207RC0000X, 207RC0000X
MA216067207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24736082Medicaid
I63524Medicare UPIN
CO24736082Medicaid