Provider Demographics
NPI:1528592391
Name:MOLT, BETHANY LANAE (DO)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:LANAE
Last Name:MOLT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 MOON RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-8757
Mailing Address - Country:US
Mailing Address - Phone:317-839-2513
Mailing Address - Fax:317-839-2513
Practice Address - Street 1:727 MOON RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-8757
Practice Address - Country:US
Practice Address - Phone:317-839-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227364207R00000X
IN02006030A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine