Provider Demographics
NPI:1528105392
Name:MOLTER, DARRON J (MD)
Entity type:Individual
Prefix:DR
First Name:DARRON
Middle Name:J
Last Name:MOLTER
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7098
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:3980 HIGHWAY 9 E STE 100A
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8163
Practice Address - Country:US
Practice Address - Phone:843-390-8320
Practice Address - Fax:843-390-8329
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT21893Medicaid
SCA8981OtherMEDCAST
SC080182121Medicare PIN
SCA8981OtherMEDCAST
E51460Medicare UPIN