Provider Demographics
NPI:1780034082
Name:HANCOCK, MOLLY (PA-C)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 S CHADWICK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4726
Mailing Address - Country:US
Mailing Address - Phone:717-329-4214
Mailing Address - Fax:215-952-9731
Practice Address - Street 1:1015 CHESTNUT ST STE 1020
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4310
Practice Address - Country:US
Practice Address - Phone:215-955-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant