Provider Demographics
NPI:1578661658
Name:MOLINERO, KENNETH G JR (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:G
Last Name:MOLINERO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2315 MYRTLE ST STE L10
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4611
Mailing Address - Country:US
Mailing Address - Phone:814-454-2401
Mailing Address - Fax:814-459-5992
Practice Address - Street 1:2315 MYRTLE ST STE L10
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4611
Practice Address - Country:US
Practice Address - Phone:814-454-2401
Practice Address - Fax:814-459-5992
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012151207XX0801X
TXM6776207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102764429Medicaid
TX8B7355OtherBCBS
TX8B7355OtherBCBS
TX8J9215Medicare PIN