Provider Demographics
NPI:1881085306
Name:ENNIS, MOLLY E (PA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:E
Last Name:ENNIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:FIOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4600 MCAULEY PL STE 600
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4778
Mailing Address - Country:US
Mailing Address - Phone:877-692-7780
Mailing Address - Fax:
Practice Address - Street 1:47185 COOPER FOSTER PARK RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-3307
Practice Address - Country:US
Practice Address - Phone:440-960-3954
Practice Address - Fax:440-960-3956
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004354RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3025372Medicaid
OH0135157Medicaid
OH9376891Medicare PIN
OH9389631Medicare PIN
OH0135157Medicaid
OHH324061Medicare PIN