Provider Demographics
NPI:1689007023
Name:MOLZ, ERIN BAMBERGER (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:BAMBERGER
Last Name:MOLZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:E
Other - Last Name:BAMBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2454 KIPLING AVE
Mailing Address - Street 2:STE. 120
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6650
Mailing Address - Country:US
Mailing Address - Phone:513-981-6784
Mailing Address - Fax:513-853-4085
Practice Address - Street 1:2454 KIPLING AVE
Practice Address - Street 2:STE. 120
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6650
Practice Address - Country:US
Practice Address - Phone:513-981-6784
Practice Address - Fax:513-853-4085
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant