Healthcare Provider Details

I. General information

NPI: 1790935849
Provider Name (Legal Business Name): M ELLEN BABIN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CEDAR ST
HYANNIS MA
02601-3009
US

IV. Provider business mailing address

65 CEDAR ST
HYANNIS MA
02601-3009
US

V. Phone/Fax

Practice location:
  • Phone: 508-790-0611
  • Fax:
Mailing address:
  • Phone: 508-790-0611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number296
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: