Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | D0085268 | MD |
Y | 2080P0207X | Pediatric Hematology-Oncologist | D0085268 | MD |
NPI | 1043622855 |
---|---|
Provider Name | John Molina |
First Address | Baltimore, MD 21287-0010 |
Second Address | Baltimore, MD 21287-0010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 22/01/2020 |