Healthcare Provider Details

I. General information

NPI: 1467677781
Provider Name (Legal Business Name): EVA SIEPKA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MILL ST SUITE 109
ARLINGTON MA
02476-4784
US

IV. Provider business mailing address

NORTHEAST MEDICAL PRACTICE INC 41 MALL ROAD
BURLINGTON MA
01805
US

V. Phone/Fax

Practice location:
  • Phone: 781-648-7707
  • Fax: 781-648-2981
Mailing address:
  • Phone: 781-744-8085
  • Fax: 781-744-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1267
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: