Individual
MOLLIE A. MACCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17 PROSPECT ST, NASHUA, NH 03060-3956
(603) 883-8311
(603) 883-8317
Mailing address
PO BOX 3677, NASHUA, NH 03061-3677
(603) 577-7900
(603) 577-7972
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
215758
MA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
17581
NH
207ND0101X
MOHS-Micrographic Surgery Physician
215758
MA
207NS0135X
Procedural Dermatology Physician
215758
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110037844A
—
MA
Enumeration date
10/16/2006
Last updated
02/15/2021
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