Healthcare Provider Details

I. General information

NPI: 1942641816
Provider Name (Legal Business Name): KELLY ANNE PASTOR P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CAMBRIDGE ST
BURLINGTON MA
01803-3766
US

IV. Provider business mailing address

46B DOMINION RD
WORCESTER MA
01605-2367
US

V. Phone/Fax

Practice location:
  • Phone: 781-272-4667
  • Fax:
Mailing address:
  • Phone: 508-450-3922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: