Provider Demographics
NPI:1851843809
Name:PRINCE, MOLLY RAE (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:RAE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:1245 HIGHLAND AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3714
Mailing Address - Country:US
Mailing Address - Phone:215-887-2010
Mailing Address - Fax:215-887-3291
Practice Address - Street 1:1245 HIGHLAND AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3714
Practice Address - Country:US
Practice Address - Phone:215-887-2010
Practice Address - Fax:215-887-3291
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2018-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA058702363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical