Healthcare Provider Details

I. General information

NPI: 1952341919
Provider Name (Legal Business Name): PATRICIA MARIE CERRETO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 HUDSON RD
BOLTON MA
01740-1444
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 978-779-6262
  • Fax:
Mailing address:
  • Phone: 800-225-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAP1791
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: