Healthcare Provider Details

I. General information

NPI: 1003881772
Provider Name (Legal Business Name): AMY LEE MOLTEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON STREET, BOX 7051 TUFTS MEDICAL CENTER-FLOATING HOSPITAL FOR CHILDREN
BOSTON MA
02111
US

IV. Provider business mailing address

800 WASHINGTON STREET, BOX 7051 TUFTS MEDICAL CENTER-FLOATING HOSPITAL FOR CHILDREN
BOSTON MA
02111
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number043168
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number246846
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: