Provider Demographics
NPI:1710216155
Name:VINCENT, MOLLY GILDEA (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:GILDEA
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:SZRAMOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5166 KEYSTONE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-2540
Mailing Address - Country:US
Mailing Address - Phone:412-310-1737
Mailing Address - Fax:
Practice Address - Street 1:3459 5TH AVE FL 7
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3236
Practice Address - Country:US
Practice Address - Phone:412-692-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103206914Medicaid
279266Medicare PIN