Provider Demographics
NPI:1821668005
Name:DOW, MOLLY KATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHERINE
Last Name:DOW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HIGH ST UNIT 516
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5195
Mailing Address - Country:US
Mailing Address - Phone:207-624-2846
Mailing Address - Fax:
Practice Address - Street 1:66 BRAMHALL ST STE G1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3344
Practice Address - Country:US
Practice Address - Phone:207-662-3157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant