Provider Demographics
NPI:1912995168
Name:MOLLOY, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:MOLLOY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:104 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1801
Mailing Address - Country:US
Mailing Address - Phone:724-482-6062
Mailing Address - Fax:724-482-6117
Practice Address - Street 1:104 TECHNOLOGY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1801
Practice Address - Country:US
Practice Address - Phone:724-482-6062
Practice Address - Fax:724-482-6117
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-06-12
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Provider Licenses
StateLicense IDTaxonomies
PAMD038916E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011595630010Medicaid
PAE12906Medicare UPIN
PA0011595630010Medicaid