Organization
MOCA ORSO LLC
Active
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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