Provider Demographics
NPI:1033444518
Name:ROLA, LEIGH ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:ROLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:MAILMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3550 MARKET ST
Mailing Address - Street 2:2ND FLOOR - PEDIATRIC DERMATOLOGY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3329
Mailing Address - Country:US
Mailing Address - Phone:215-590-2169
Mailing Address - Fax:215-590-4948
Practice Address - Street 1:3550 MARKET ST
Practice Address - Street 2:2ND FLOOR - PEDIATRIC DERMATOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3329
Practice Address - Country:US
Practice Address - Phone:215-590-2169
Practice Address - Fax:215-590-4948
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant