Healthcare Provider Details

I. General information

NPI: 1003248352
Provider Name (Legal Business Name): GRETCHEN DAVIDSON PLATT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 PROVIDENCE HWY
EAST WALPOLE MA
02032-1512
US

IV. Provider business mailing address

103 PROVIDENCE HWY
EAST WALPOLE MA
02032-1512
US

V. Phone/Fax

Practice location:
  • Phone: 781-255-0500
  • Fax: 781-255-0400
Mailing address:
  • Phone: 781-255-0500
  • Fax: 781-255-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4729
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: