Healthcare Provider Details

I. General information

NPI: 1851058937
Provider Name (Legal Business Name): MOLLY CHRISTINE ROTH PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 ROOSEVELT AVE STE B
YORK PA
17408-8521
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-4090
  • Fax: 717-798-3687
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA063199
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: