Provider Demographics
NPI:1942381546
Name:MOLANO, WILFREDO N (MD)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:N
Last Name:MOLANO
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 428
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-0428
Mailing Address - Country:US
Mailing Address - Phone:304-988-9191
Mailing Address - Fax:304-988-9193
Practice Address - Street 1:8213 SISSONVILLE DR
Practice Address - Street 2:
Practice Address - City:SISSONVILLE
Practice Address - State:WV
Practice Address - Zip Code:25320-9602
Practice Address - Country:US
Practice Address - Phone:304-988-9191
Practice Address - Fax:304-988-9193
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10473261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVB42826Medicare UPIN
WV8802215Medicare PIN