Healthcare Provider Details

I. General information

NPI: 1720802820
Provider Name (Legal Business Name): EMMA CONNOLLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 JEFFERSON AVE
SCRANTON PA
18510-1624
US

IV. Provider business mailing address

206 WILLOW WAY
MAYFIELD PA
18433-2048
US

V. Phone/Fax

Practice location:
  • Phone: 570-770-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA065711
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: