Provider Demographics
NPI:1871713859
Name:MOLITIERNO, JOSEPH A JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:MOLITIERNO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602148
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2148
Mailing Address - Country:US
Mailing Address - Phone:704-381-3510
Mailing Address - Fax:704-540-3668
Practice Address - Street 1:3125 SPRINGBANK LN
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3379
Practice Address - Country:US
Practice Address - Phone:704-381-3510
Practice Address - Fax:704-540-3668
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-013642088P0231X
SC295642088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC201047OtherMEDCOST
SC295647Medicaid
NC5907391Medicaid
SC9295059OtherAETNA