Provider Demographics
NPI:1295732287
Name:MOLLOV, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MOLLOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:600 PRIMROSE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2659
Mailing Address - Country:US
Mailing Address - Phone:978-556-1000
Mailing Address - Fax:978-556-0094
Practice Address - Street 1:600 PRIMROSE ST STE 202
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2659
Practice Address - Country:US
Practice Address - Phone:978-556-1000
Practice Address - Fax:978-556-0100
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA42450207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2064057Medicaid
A54060Medicare UPIN
D11111Medicare UPIN