Provider Demographics
NPI:1306330006
Name:ABOUREZK, MOLLY D (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:D
Last Name:ABOUREZK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:D
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5115 CENTRE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1301
Mailing Address - Country:US
Mailing Address - Phone:412-864-6600
Mailing Address - Fax:412-864-6601
Practice Address - Street 1:5115 CENTRE AVE FL 3
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1301
Practice Address - Country:US
Practice Address - Phone:412-864-6600
Practice Address - Fax:412-864-6601
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005605RX363A00000X
PAMA064605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0309647Medicaid