Provider Demographics
NPI:1902839152
Name:RAD, MOLLY (MD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:RAD
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 1:763 ALTOS OAKS DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5496
Mailing Address - Country:US
Mailing Address - Phone:650-864-0000
Mailing Address - Fax:650-864-0014
Practice Address - Street 1:763 ALTOS OAKS DR
Practice Address - Street 2:SUITE 4
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5496
Practice Address - Country:US
Practice Address - Phone:650-864-0000
Practice Address - Fax:650-864-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53648174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7884034Medicare UPIN