Provider Demographics
NPI:1326866005
Name:CUNNING, MOLLY ELIZABETH
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:CUNNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 JERUSALEM ROAD DR
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1131
Mailing Address - Country:US
Mailing Address - Phone:781-534-3738
Mailing Address - Fax:
Practice Address - Street 1:214 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1354
Practice Address - Country:US
Practice Address - Phone:781-534-3738
Practice Address - Fax:212-385-3703
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032659363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant