Provider Demographics
NPI:1912077520
Name:HASTINGS, MOLLY MAHON (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MAHON
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:426 INDUSTRIAL AVE
Mailing Address - Street 2:STE 132
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-4448
Mailing Address - Country:US
Mailing Address - Phone:802-497-0916
Mailing Address - Fax:802-878-9797
Practice Address - Street 1:426 INDUSTRIAL AVE
Practice Address - Street 2:STE 132
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4448
Practice Address - Country:US
Practice Address - Phone:802-497-0916
Practice Address - Fax:802-878-9797
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2013-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT0420009333207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1444Medicaid
VTOVN1444Medicaid