MEDICARE: OLIVIA MARIE DRISCOLL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	25MP00986200	NJ

General Provider Information

NPI Number	:	1508729906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA MARIE DRISCOLL PA-C

Provider Business Mailing Address
First Line	:	18 BARNARD AVE
Second Line	:
City	:	GLOUCESTER CITY
State	:	NJ
Zip	:	08030-2101
Country	:	US
Telephone Number	:	856-470-0429
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 N 39TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2640
Country	:	US
Telephone Number	:	215-662-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	03/03/2026

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