Provider Demographics
NPI:1720002496
Name:MOLLOY, LOULIE BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:LOULIE
Middle Name:BRADLEY
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOULIE
Other - Middle Name:MOLLOY
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD602112252085R0202X
AK48082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0407083OtherLNI-SEATTLE RADIOLOGY
WA0279542OtherLNI-RADIA REST OF WA
WA2077576Medicaid
WA0377842OtherLNI-SWEDISH RADIA EDMONDS
WA0377840OtherLNI-RADIA KING COUNTY
WA0377848OtherLNI-EVERGREEN RADIA
WA0414953OtherLNI-SOUTH SOUND RADIOLOGY