Healthcare Provider Details

I. General information

NPI: 1598743569
Provider Name (Legal Business Name): KEVIN C TRAINA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 SOUTH ST
SOUTHBRIDGE MA
01550-4000
US

IV. Provider business mailing address

PO BOX 40
SOUTHBRIDGE MA
01550-0040
US

V. Phone/Fax

Practice location:
  • Phone: 508-764-2772
  • Fax: 508-764-2833
Mailing address:
  • Phone: 508-909-7799
  • Fax: 508-764-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number412
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: