Provider Demographics
NPI:1720121684
Name:MOLLOY, ALLEN R (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:R
Last Name:MOLLOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411804
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-1804
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:484-924-0053
Practice Address - Street 1:1 NW 64TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9107
Practice Address - Country:US
Practice Address - Phone:572-218-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361634882085R0204X
OK223342085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200106970AMedicaid
OK249722912OtherMEDICARE
OKP00974065OtherMEDICARE RAILROAD (RALLC)
OK248722910OtherMEDICARE
OKOKAAA0340 (MPI)Medicare PIN
OKOKAAA0334 (AI)Medicare PIN
OK249722912OtherMEDICARE