Provider Demographics
NPI:1396975009
Name:VAN MOL, ELLEN CHASE (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:CHASE
Last Name:VAN MOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9914 EQUUS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:60611-5359
Mailing Address - Country:US
Mailing Address - Phone:706-296-6555
Mailing Address - Fax:
Practice Address - Street 1:1000 N OLIVE AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3512
Practice Address - Country:US
Practice Address - Phone:561-557-1767
Practice Address - Fax:561-327-5125
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine