Healthcare Provider Details

I. General information

NPI: 1366944720
Provider Name (Legal Business Name): KELLY ANN MOLSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 FARMINGTON AVE
FARMINGTON CT
06032-1916
US

IV. Provider business mailing address

510 BUTTERNUT ST
MIDDLETOWN CT
06457-3507
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-1824
  • Fax:
Mailing address:
  • Phone: 860-853-8191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number005045
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: