Healthcare Provider Details

I. General information

NPI: 1922365840
Provider Name (Legal Business Name): MOLLY KRUGER NAPLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21B ARTS CENTER CT
AVON CT
06001-3752
US

IV. Provider business mailing address

21B ARTS CENTER CT
AVON CT
06001-3752
US

V. Phone/Fax

Practice location:
  • Phone: 860-248-0000
  • Fax:
Mailing address:
  • Phone: 860-248-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54216
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: