MEDICARE: JOSEPH A. MOLITIERNO JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2088P0231X	Pediatric Urology Physician	2006-01364	NC
2	2088P0231X	Pediatric Urology Physician	29564	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201047	OTHER	SC	MEDCOST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	9295059	OTHER	SC	AETNA

General Provider Information

NPI Number	:	1871713859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH A. MOLITIERNO JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 602148
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2148
Country	:	US
Telephone Number	:	704-381-3510
Fax Number	:	704-540-3668

Provider Business Practice Location Address
First Line	:	3125 SPRINGBANK LN
Second Line	:	SUITE E
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3379
Country	:	US
Telephone Number	:	704-381-3510
Fax Number	:	704-540-3668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/29/2013

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