Provider Demographics
NPI:1851058937
Name:ROTH, MOLLY CHRISTINE (PAC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:CHRISTINE
Last Name:ROTH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-4090
Mailing Address - Fax:717-798-3687
Practice Address - Street 1:1695 ROOSEVELT AVE STE B
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8521
Practice Address - Country:US
Practice Address - Phone:717-812-4090
Practice Address - Fax:717-798-3687
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA063199363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant