Provider Demographics
NPI:1396977179
Name:SOMAINI, MOLLY G (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:G
Last Name:SOMAINI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:E
Other - Last Name:GORMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:260 CREST RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-9503
Mailing Address - Country:US
Mailing Address - Phone:802-524-8805
Mailing Address - Fax:802-524-8488
Practice Address - Street 1:150 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6749
Practice Address - Country:US
Practice Address - Phone:802-484-9370
Practice Address - Fax:802-448-1414
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0031059363A00000X
VT055-0031058363A00000X
VT055-0030981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant