Provider Demographics
NPI:1912198243
Name:MOLL, CHRISTINA L (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:MOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1101 MEDICAL CENTER BLVD.
Mailing Address - Street 2:HOSPITALIST DEPARTMENT
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-349-1656
Mailing Address - Fax:504-349-1933
Practice Address - Street 1:1101 MEDICAL CENTER BLVD.
Practice Address - Street 2:HOSPITALIST DEPARTMENT
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-1656
Practice Address - Fax:504-349-1933
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2018-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0116023362207RN0300X
LAMD202032208000000X, 207R00000X
LAMD.202032208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1507873Medicaid