Provider Demographics
NPI:1265886873
Name:ANDERSEN, MOLLY (DO)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:MCCORMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7519 BLUE FOX RUN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6336
Mailing Address - Country:US
Mailing Address - Phone:513-379-0893
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005586A207P00000X, 207P00000X
IL036-147948207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine