Healthcare Provider Details

I. General information

NPI: 1932572732
Provider Name (Legal Business Name): ALICIA AMADORI PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE
BOSTON MA
02120-2847
US

IV. Provider business mailing address

125 PARKER HILL AVE
BOSTON MA
02120-2847
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-5000
  • Fax:
Mailing address:
  • Phone: 617-754-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA5371
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: