Provider Demographics
NPI:1265624613
Name:PATRICK A. MOLONY, MD PA
Entity type:Organization
Organization Name:PATRICK A. MOLONY, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOLONY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-546-3041
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:1800 COMBS ROAD SUITE 11
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-0557
Mailing Address - Country:US
Mailing Address - Phone:276-546-3041
Mailing Address - Fax:276-546-1525
Practice Address - Street 1:1800 COMBS RD
Practice Address - Street 2:SUITE 11
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-1808
Practice Address - Country:US
Practice Address - Phone:276-546-3041
Practice Address - Fax:276-546-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022999261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007610807Medicaid
VA007610815Medicaid
VA007610807Medicaid
VA493863Medicare Oscar/Certification