Provider Demographics
NPI:1518931617
Name:MOLINSKI, RICHARD (PA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MOLINSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAMP ATTERBURY
Mailing Address - Street 2:7812 MSU DET 1
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:46124
Mailing Address - Country:US
Mailing Address - Phone:270-304-6571
Mailing Address - Fax:
Practice Address - Street 1:CAMP ATTERBURY
Practice Address - Street 2:7812 MSU DET 1
Practice Address - City:EDINBURGH
Practice Address - State:IN
Practice Address - Zip Code:46124
Practice Address - Country:US
Practice Address - Phone:270-304-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2401363A00000X
FLPA2401207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290271100Medicaid
FL970008725OtherRAILROAD
S58197Medicare UPIN
FL970008725OtherRAILROAD