Provider Demographics
NPI:1043540750
Name:MOLLOY, SUSAN PATRICIA (RDCS(AE))
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:PATRICIA
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:RDCS(AE)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 FALMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-2699
Mailing Address - Country:US
Mailing Address - Phone:617-733-5095
Mailing Address - Fax:
Practice Address - Street 1:509 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-2699
Practice Address - Country:US
Practice Address - Phone:617-733-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32450246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography