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NPI Code Detail

MEDICARE: MICHELLE VIDAL PA-C

MEDICARE: MICHELLE VIDAL PA-C
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
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician AssistantPA7369MA

General Provider Information

NPI Number : 1427618727
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE VIDAL PA-C
Provider Business Mailing Address
First Line : 23 PINE ST UNIT D
Second Line :
City : CANTON
State : MA
Zip : 02021-3346
Country : US
Telephone Number : 617-480-3188
Fax Number :
Provider Business Practice Location Address
First Line : 3 WASHINGTON ST STE 200
Second Line :
City : NORTH EASTON
State : MA
Zip : 02356-1034
Country : US
Telephone Number : 617-480-3188
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2019
Last Update Date : 07/30/2025

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Directions to “ MICHELLE VIDAL PA-C” Practice Location

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