Provider Demographics
NPI:1003896796
Name:MOLINA, RAFAEL EVENCIO (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:EVENCIO
Last Name:MOLINA
Suffix:
Gender:M
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 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1630 13TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3812
Practice Address - Country:US
Practice Address - Phone:304-697-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086645207V00000X
WV21985207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000368678OtherANTHEM BC
WV3810001850Medicaid
OH001709561OtherMT. STATE
KY64107105Medicaid
WV001709560OtherMT. STATE
OH2613578Medicaid
OH2613578Medicaid
WVWV2807Medicare PIN
WV2026585Medicare PIN
WV2026581Medicare PIN
WVWV2807AMedicare PIN
WV001709560OtherMT. STATE
WVWV2807C197Medicare PIN
WV2026584Medicare PIN
OH001709561OtherMT. STATE
OH2026583Medicare PIN