Provider Demographics
NPI:1225253792
Name:MOLTA, CHARLES THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:MOLTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1583 MAPLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301
Mailing Address - Country:US
Mailing Address - Phone:610-322-6399
Mailing Address - Fax:253-322-6390
Practice Address - Street 1:500 ARCOLA ROAD
Practice Address - Street 2:E6232
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426
Practice Address - Country:US
Practice Address - Phone:484-865-2375
Practice Address - Fax:253-322-6390
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD433419207RR0500X
OH35053258207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA16950Medicare UPIN
OHCH0865851Medicare ID - Type Unspecified