Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35097316 | OH |
N | 207ND0101X | MOHS-Micrographic Surgeon | 35097316 | OH |
N | 207NS0135X | Procedural Dermatology | 35097316 | OH |
NPI | 1164621579 |
---|---|
Provider Name | Dr. Matthew A Molenda |
First Address | Toledo, OH 43623-3075 |
Second Address | Toledo, OH 43623-3075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 05/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0081818 | (05) | OH |