Provider Demographics
NPI:1053301358
Name:MOLLOY, MARCELYN CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:MARCELYN
Middle Name:CAROL
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:75 HOLLY HILL LN
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6098
Mailing Address - Country:US
Mailing Address - Phone:203-869-6960
Mailing Address - Fax:203-869-5103
Practice Address - Street 1:75 HOLLY HILL LN
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6098
Practice Address - Country:US
Practice Address - Phone:203-869-6960
Practice Address - Fax:203-869-5103
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT052486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0152706Medicaid
MAA33031Medicare ID - Type Unspecified
MA208428OtherTUFTS HEALTH PLAN
MAJ24009OtherBCBS MA
H50910Medicare UPIN