Organization
PEDIATRIC UROLOGY ASSOCIATES
Active
Other names
Pediatric Urology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH A. MOLITIESM JR. M.D. (COO)
(407) 540-3667
Entity
Organization
Contact information
Practice address
3135 SPRINGBANK LANE, SUITE 200, CHARLOTTE, NC 28226-3360
(704) 540-3667
(704) 540-3668
Mailing address
3135 SPRINGBANK LANE, SUITE 200, CHARLOTTE, NC 28226-3360
(704) 540-3667
(704) 540-3668
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
9600282
NC
363AM0700X
Medical Physician Assistant
1000392
NC
363AM0700X
Medical Physician Assistant
103556
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02367
BCBS
NC
05
—
51818
—
NC
05
—
8951818
—
NC
Enumeration date
05/11/2006
Last updated
08/05/2015
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