Provider Demographics
NPI:1053548826
Name:PATRICK, CAITLYN MOLINO (MD)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MOLINO
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2409
Mailing Address - Country:US
Mailing Address - Phone:757-481-4817
Mailing Address - Fax:757-481-7138
Practice Address - Street 1:1101 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2409
Practice Address - Country:US
Practice Address - Phone:757-481-4817
Practice Address - Fax:757-481-7138
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260097207RG0100X
NC2012-00339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053548826Medicaid
VA1053548826Medicaid