Healthcare Provider Details

I. General information

NPI: 1902163975
Provider Name (Legal Business Name): ERMAL MOLLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 S MAIN ST
MIDDLETOWN CT
06457-3649
US

IV. Provider business mailing address

28 CRESCENT ST
MIDDLETOWN CT
06457-3650
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-8680
  • Fax:
Mailing address:
  • Phone: 860-358-8680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number56975
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: