Basic Information
| Provider Information | |||||||||
| NPI: | 1578661658 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLINERO | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 PLAZA DRIVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BELLE VERNON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150124019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243795813 | ||||||||
| FaxNumber: | 7243795874 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 PLAZA DRIVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BELLE VERNON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243795802 | ||||||||
| FaxNumber: | 7243795813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0801X | OS012151 | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
ID Information
| ID | Type | State | Issuer | Description | 102764429 | 05 | PA | MEDICAID |