Healthcare Provider Details

I. General information

NPI: 1124049069
Provider Name (Legal Business Name): MARISA FIGUEIREDO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE MS GI III
BOSTON MA
02130-4817
US

IV. Provider business mailing address

375A HARVARD ST APT 6A
CAMBRIDGE MA
02138-4122
US

V. Phone/Fax

Practice location:
  • Phone: 617-705-5678
  • Fax:
Mailing address:
  • Phone: 617-232-9500
  • Fax: 857-364-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1173
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: