Provider Demographics
NPI:1518129741
Name:SHIPMAN, MOLLY MARGARET (DO)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:MARGARET
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:60 WESTWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2460
Mailing Address - Country:US
Mailing Address - Phone:203-573-1425
Mailing Address - Fax:203-573-1425
Practice Address - Street 1:60 WESTWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2460
Practice Address - Country:US
Practice Address - Phone:203-573-1425
Practice Address - Fax:203-573-1425
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62770390200000X
CT050352207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program