Provider Demographics
NPI:1770209454
Name:CHORBA, MOLLEE (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLEE
Middle Name:
Last Name:CHORBA
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 1:1000 MEADE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3197
Mailing Address - Country:US
Mailing Address - Phone:570-871-4445
Mailing Address - Fax:570-871-4532
Practice Address - Street 1:1000 MEADE ST STE 204
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3197
Practice Address - Country:US
Practice Address - Phone:570-871-4445
Practice Address - Fax:570-871-4532
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064052363AM0700X
PAOA006738363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104134041-0004Medicaid