Healthcare Provider Details

I. General information

NPI: 1447731765
Provider Name (Legal Business Name): KARA LOUISE RUGGIERO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 CENTRE ST
BROCKTON MA
02302-3308
US

IV. Provider business mailing address

2 HANCOCK ST APT 423
QUINCY MA
02171-1763
US

V. Phone/Fax

Practice location:
  • Phone: 508-941-7700
  • Fax: 508-941-6334
Mailing address:
  • Phone: 339-235-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6526
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: