Provider Demographics
NPI:1780987594
Name:PFEIFFER, MOLLY MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:MARIE
Last Name:PFEIFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1965
Mailing Address - Country:US
Mailing Address - Phone:330-343-1144
Mailing Address - Fax:
Practice Address - Street 1:340 OXFORD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1965
Practice Address - Country:US
Practice Address - Phone:330-343-0753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.003142OtherLICENSE
H075230OtherMEDICARE