MEDICARE: DR. ELLEN DE MOLL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	64827	CT

General Provider Information

NPI Number	:	1518349877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN DE MOLL MD

Provider Business Mailing Address
First Line	:	38 EAST AVE
Second Line	:
City	:	NEW CANAAN
State	:	CT
Zip	:	06840-5516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 EAST AVE
Second Line	:
City	:	NEW CANAAN
State	:	CT
Zip	:	06840-5516
Country	:	US
Telephone Number	:	203-200-0523
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2015
Last Update Date	:	01/18/2025

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Directions to “ DR. ELLEN DE MOLL MD” Practice Location

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