Provider Demographics
NPI:1144279571
Name:MOLINA, MARIA C (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-6309
Mailing Address - Country:US
Mailing Address - Phone:609-567-0200
Mailing Address - Fax:609-704-5615
Practice Address - Street 1:860 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2018
Practice Address - Country:US
Practice Address - Phone:609-567-0200
Practice Address - Fax:609-567-1951
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA062731002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6780105Medicaid
NJ2K3590OtherHEALTHNET PROVIDER NUMBER
NJ3183156OtherAETNA PROVIDER NUMBER
NJ177909OtherCONSUMER HEALTH NETWORK
NJP2899068OtherOXFORD PROVIDER NUMBER
NJ1172828OtherHORIZON NJ HEALTH PROV #
NJ6780105Medicaid