Healthcare Provider Details

I. General information

NPI: 1720829716
Provider Name (Legal Business Name): LIAM E PONTES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PAGE ST
NEW BEDFORD MA
02740-3464
US

IV. Provider business mailing address

101 PAGE ST
NEW BEDFORD MA
02740-3464
US

V. Phone/Fax

Practice location:
  • Phone: 413-565-1317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberA102772
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: