Active NPI
Molly Deisroth-Kim, MS
- Clinical Exercise Physiologist
- Waltham, MA
National Provider Identifier
1427323625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Exercise Physiologist
- License
- 127683
- Practice address
- 40 2ND Ave
Suite 510
Waltham, MA 02451-1132 - Phone
- (781) 487-6103
- NPI assigned
- Mar 20, 2012
- Last updated
- Mar 20, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Exercise Physiologist | 224Y00000X | 127683 | IN | Primary |
Addresses
Primary practice location
40 2ND Ave
Suite 510
Waltham, MA 02451-1132
Mailing address
20 Green Way
Wayland, MA 01778-2626
Phone (508) 358-4435
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 127683 | IN | MD | Clinical Exercise Physiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332201600000",
"number": "1427323625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 GREEN WAY",
"city": "WAYLAND",
"state": "MA",
"postal_code": "017782626",
"telephone_number": "508-358-4435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 2ND AVE",
"address_2": "SUITE 510",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024511132",
"telephone_number": "781-487-6103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEISROTH-KIM",
"first_name": "MOLLY",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-20",
"last_updated": "2012-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "224Y00000X",
"taxonomy_group": "",
"desc": "Clinical Exercise Physiologist",
"state": "IN",
"license": "127683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.