Provider Demographics
NPI:1740259373
Name:BOHAC, MELISSA ANLIE (PAC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANLIE
Last Name:BOHAC
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:570-887-2033
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004188-1363A00000X
PAMA001408L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGU039880OtherMEDICARE GROUP
PA970014969OtherRR MEDICARE PIN
NY01282104Medicaid
PACC9269OtherRR MEDICARE GROUP
NY01282104Medicaid
PA970014969OtherRR MEDICARE PIN
R07146Medicare UPIN