Provider Demographics
NPI:1780940452
Name:MCSTRAVICK, MOLLY KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:KATHLEEN
Last Name:MCSTRAVICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3144 HORIZON RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7045
Mailing Address - Country:US
Mailing Address - Phone:972-771-1935
Mailing Address - Fax:972-771-1718
Practice Address - Street 1:3144 HORIZON RD STE 220
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7045
Practice Address - Country:US
Practice Address - Phone:972-771-1935
Practice Address - Fax:972-771-1718
Is Sole Proprietor?:No
Enumeration Date:2012-04-07
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ6447207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX529325YKP5Medicare PIN
TX529325YKQLMedicare PIN