Provider Demographics
NPI:1942843024
Name:ALBORN, OLIVIA MERSHON (PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MERSHON
Last Name:ALBORN
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 1:1336 BRISTOL PIKE STE 103
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5660
Mailing Address - Country:US
Mailing Address - Phone:215-638-3444
Mailing Address - Fax:
Practice Address - Street 1:1336 BRISTOL PIKE STE 103
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5660
Practice Address - Country:US
Practice Address - Phone:215-638-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061209363AM0700X
PAOA005071363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical