Provider Information for 1578761391
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MARCO R MOLINA M.D.
Sex: Male
NPI: 1578761391
Last Updated: 2022-09-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1578761391 | ||||||||||||||
| Enumeration Date | 2007-07-03 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 263 FARMINGTON AVE PROVIDER ENROLLMENT FARMINGTON, CT 06030-2212 United States Phone: 860-679-7503 | Fax:860-679-1610 | ||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE RADIOLOGY FARMINGTON, CT 06030-2803 United States Phone: 860-679-2784 | Fax:860-679-4126 | ||||||||||||||
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