Basic Information
| Provider Information | |||||||||
| NPI: | 1770209454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHORBA | ||||||||
| FirstName: | MOLLEE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 MACK BLVD 4TH FLOOR | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191785622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705016368 | ||||||||
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| Practice Location | |||||||||
| Address1: | 564 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | HAZLETON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182016108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705016400 | ||||||||
| FaxNumber: | 5704532353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2022 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA064052 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.