Organization
MOCA ORSO LLC
Active
Other names
Maximum Wellness MD
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY BOLTON JR. MD (OWNER)
(412) 599-1039
Entity
Organization
Contact information
Practice address
4007 SKIPPACK PIKE, SKIPPACK, PA 19474-0196
(610) 584-7284
Mailing address
952 N 3RD ST, APT 601, PHILADELPHIA, PA 19123
(412) 599-1039
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001707640
—
PA
Enumeration date
09/17/2018
Last updated
06/03/2022
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