Healthcare Provider Details

I. General information

NPI: 1871713859
Provider Name (Legal Business Name): JOSEPH A. MOLITIERNO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 SPRINGBANK LN SUITE E
CHARLOTTE NC
28226-3379
US

IV. Provider business mailing address

PO BOX 602148
CHARLOTTE NC
28260-2148
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-3510
  • Fax: 704-540-3668
Mailing address:
  • Phone: 704-381-3510
  • Fax: 704-540-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number2006-01364
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number29564
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: