Healthcare Provider Details

I. General information

NPI: 1164621579
Provider Name (Legal Business Name): MATTHEW A MOLENDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 REGENCY CT STE 201
TOLEDO OH
43623-3075
US

IV. Provider business mailing address

2000 REGENCY CT STE 201
TOLEDO OH
43623-3075
US

V. Phone/Fax

Practice location:
  • Phone: 419-948-3376
  • Fax: 419-665-3632
Mailing address:
  • Phone: 419-948-3376
  • Fax: 419-665-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35097316
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number35097316
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number35097316
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: