Healthcare Provider Details

I. General information

NPI: 1649267410
Provider Name (Legal Business Name): MOLLY B HASTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E CHESTNUT ST
LOUISVILLE KY
40202-1821
US

IV. Provider business mailing address

PO BOX 2469
LOUISVILLE KY
40201-2469
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-7212
  • Fax: 502-629-5991
Mailing address:
  • Phone: 502-852-8500
  • Fax: 502-852-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number40445
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40445
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: