Provider Demographics
NPI:1831394162
Name:MOLINOFF, MARK J (LIC AC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:J
Last Name:MOLINOFF
Suffix:
Gender:M
Credentials:LIC AC
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Mailing Address - Street 1:5530 MUNFORD ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612
Mailing Address - Country:US
Mailing Address - Phone:919-815-8115
Mailing Address - Fax:866-889-6637
Practice Address - Street 1:5530 MUNFORD ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:919-815-8115
Practice Address - Fax:866-889-6637
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2016-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC341171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist