MEDICARE: KERRY EATON

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	PA8930	MA
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1164180659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY EATON

Provider Business Mailing Address
First Line	:	66 CONCORD ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-2179
Country	:	US
Telephone Number	:	978-694-9610
Fax Number	:	978-694-9533

Provider Business Practice Location Address
First Line	:	66 CONCORD ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-2179
Country	:	US
Telephone Number	:	978-694-9610
Fax Number	:

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

Provider Enumeration Date	:	12/02/2021
Last Update Date	:	02/03/2026

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Directions to “ KERRY EATON ” Practice Location

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