Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 043168 | CT |
N | 208000000X | Pediatrician | 246846 | MA |
NPI | 1003881772 |
---|---|
Provider Name | Amy Lee Molten |
First Address | Boston, MA 02111 |
Second Address | Boston, MA 02111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 05/10/2011 |