Provider Demographics
NPI:1295797181
Name:VEAL, MOLLOY G (MD)
Entity type:Individual
Prefix:
First Name:MOLLOY
Middle Name:G
Last Name:VEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7505 NEW LAGRANGE RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222
Mailing Address - Country:US
Mailing Address - Phone:502-930-2874
Mailing Address - Fax:502-339-5700
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE #195
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-897-7977
Practice Address - Fax:502-416-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2010-07-01
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Provider Licenses
StateLicense IDTaxonomies
KY19156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicaid
KYPENDINGMedicaid
PENDINGMedicare PIN