MEDICARE: MARISA P DONLIN LIC. AC.

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	171100000X	Acupuncturist	226466	MA

General Provider Information

NPI Number	:	1265582381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA P DONLIN LIC. AC.

Provider Business Mailing Address
First Line	:	111 GREEN ST UNIT 201
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2258
Country	:	US
Telephone Number	:	617-899-2692
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 GREEN ST UNIT 201
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2258
Country	:	US
Telephone Number	:	617-899-2692
Fax Number	:

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	10/07/2015

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