Provider Demographics
NPI:1477584282
Name:MOLINA, RENE PEDRO (MD)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:PEDRO
Last Name:MOLINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:717 STATE ST STE 16
Mailing Address - Street 2:REGIONAL HEALTH SERVICES
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1341
Mailing Address - Country:US
Mailing Address - Phone:814-480-7100
Mailing Address - Fax:814-480-7604
Practice Address - Street 1:300 STATE STREET
Practice Address - Street 2:LAKEVIEW UROLOGIC SURGEONS, STE 302
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507
Practice Address - Country:US
Practice Address - Phone:814-877-5700
Practice Address - Fax:814-877-5655
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD028561E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010947540003Medicaid
PA0010947540003Medicaid
C03596Medicare UPIN