Susan Lynn Mollard, NP

Primary specialty

Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X

License

F360097 Issued in NY

Practice address

585 New Loudon Road
Latham, NY 12110

Phone

(518) 783-1472

Fax

(518) 783-1605

NPI assigned

May 30, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• W Bruce Clark MD PC

  • Obstetrics & Gynecology Physician
  • Latham, NY
  • NPI 1396959110
  Medicare reassignment
• Lee and Burack OB/GYN, P.C.

  • Obstetrics & Gynecology Physician
  • Albany, NY
  • NPI 1801983788
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790986370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "585 NEW LOUDON ROAD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "12110",
            "telephone_number": "518-783-1472",
            "fax_number": "518-783-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 NEW LOUDON ROAD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "12110",
            "telephone_number": "518-783-1472",
            "fax_number": "518-783-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLARD",
        "first_name": "SUSAN",
        "middle_name": "LYNN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "NY",
            "license": "F360097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richelle Beverly Mitchell, M.S. SLP
• Mobile Imaging LTD.
• Mobile Imaging LTD.
• Racquel Marie Mochrie, FNP-BC
• Loren Moffitt
• Desiree Joyce Mollnow, FNP-BC
• Monroe Wheelchair Inc
• Joseph Michael Monserrat, PSYD.
• Neeta Moonka, M.D.
• Taylor Suzanne Moore, FNP-C

• Obstetrics & Gynecology Nurse Practitioner in Latham, NY
• Providers in Latham, NY by specialty
• Obstetrics & Gynecology Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.