Healthcare Provider Details

I. General information

NPI: 1871627133
Provider Name (Legal Business Name): MARIA G MOLINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 GOOD DR
LANCASTER PA
17601-2426
US

IV. Provider business mailing address

1776 WOODSTEAD CT STE 208
THE WOODLANDS TX
77380-1480
US

V. Phone/Fax

Practice location:
  • Phone: 877-749-7428
  • Fax: 512-628-3314
Mailing address:
  • Phone: 877-749-7428
  • Fax: 512-628-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD053197L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMA06921900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: