Provider Demographics
NPI:1730542424
Name:MOZAL, CHANTEL PRIOLO (MPH, PA-C)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:PRIOLO
Last Name:MOZAL
Suffix:
Gender:F
Credentials:MPH, PA-C
Other - Prefix:
Other - First Name:CHANTEL
Other - Middle Name:ANELLA
Other - Last Name:PRIOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, PA-C
Mailing Address - Street 1:1102 BALTIMORE PIKE STE 202
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1058
Mailing Address - Country:US
Mailing Address - Phone:610-558-1446
Mailing Address - Fax:610-486-3015
Practice Address - Street 1:1102 BALTIMORE PIKE STE 202
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1058
Practice Address - Country:US
Practice Address - Phone:610-558-1446
Practice Address - Fax:610-486-3015
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0001054363AM0700X
PAMA063208363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical