Provider Demographics
NPI:1700109832
Name:MOLLOY G. VEAL MD PSC
Entity Type:Organization
Organization Name:MOLLOY G. VEAL MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLOY
Authorized Official - Middle Name:G
Authorized Official - Last Name:VEAL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:502-930-2874
Mailing Address - Street 1:3900 KRESGE WAY
Mailing Address - Street 2:SUITE 50
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4660
Mailing Address - Country:US
Mailing Address - Phone:502-930-2874
Mailing Address - Fax:502-339-5700
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 50
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-930-2874
Practice Address - Fax:502-339-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty