Provider Demographics
NPI:1760662878
Name:MIDDLETON, MOLLY CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:CHRISTINE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HARBERT DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-5117
Mailing Address - Country:US
Mailing Address - Phone:937-208-7575
Mailing Address - Fax:937-208-7590
Practice Address - Street 1:111 HARBERT DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-5117
Practice Address - Country:US
Practice Address - Phone:937-208-7575
Practice Address - Fax:937-208-7590
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35094164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3085478Medicaid
OH3085478Medicaid