Healthcare Provider Details

I. General information

NPI: 1922747104
Provider Name (Legal Business Name): DARRAGH MICHAEL HEFFERNAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 ELMWOOD AVE
QUINCY MA
02170-1327
US

IV. Provider business mailing address

184 ELMWOOD AVE
QUINCY MA
02170-1327
US

V. Phone/Fax

Practice location:
  • Phone: 781-367-8367
  • Fax:
Mailing address:
  • Phone: 781-367-8367
  • 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: