Provider Demographics
NPI:1164436127
Name:EMOTT, MOLLY M (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:M
Last Name:EMOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 SILAS DEANE HIGHWAY
Mailing Address - Street 2:HHC - CVO
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HAZARD AVE STE 101
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5447
Practice Address - Country:US
Practice Address - Phone:860-456-2898
Practice Address - Fax:860-456-3078
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268856207RE0101X
CT47509207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT047509OtherLICENSE
VT042-11351OtherLICENSE
VT042-11351OtherLICENSE