Provider Demographics
NPI:1295875409
Name:FROST MOLLE, MARY JOAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOAN
Last Name:FROST MOLLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:JOAN
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10237 BRADLEY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3907
Mailing Address - Country:US
Mailing Address - Phone:410-884-3457
Mailing Address - Fax:
Practice Address - Street 1:7180 COLUMBIA GATEWAY DR
Practice Address - Street 2:HOWARD COUHTY HEALTH DEPT.
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2132
Practice Address - Country:US
Practice Address - Phone:410-313-7500
Practice Address - Fax:410-313-7502
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine