Provider Demographics
NPI:1710953203
Name:ROLSTON, PAUL HOWELL (, MMSC, PA-C)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:HOWELL
Last Name:ROLSTON
Suffix:
Gender:M
Credentials:, MMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2201 PENNSYLVANIA AVE
Mailing Address - Street 2:APT # 803
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3513
Mailing Address - Country:US
Mailing Address - Phone:215-587-0777
Mailing Address - Fax:
Practice Address - Street 1:NORTHEASTERN HOSPITAL
Practice Address - Street 2:2186 ALLEGHENY ROAD
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-291-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA052239363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP92876Medicare UPIN
PA096154Medicare ID - Type Unspecified