Healthcare Provider Details

I. General information

NPI: 1417391863
Provider Name (Legal Business Name): MOLLIE G. WARREN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2013
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST # 4
BOSTON MA
02115-6110
US

IV. Provider business mailing address

18 GIBBS ST APT 2
BROOKLINE MA
02446-6032
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-4120
  • Fax:
Mailing address:
  • Phone: 508-733-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33576
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD25493
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD18850
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number287409
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: