=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326478116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTINE TROTTA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2013
-----------------------------------------------------
Last Update Date | 11/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 LYNE RD
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02135-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-566-8829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 LYNE RD
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02135-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-566-8829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN ASSISTANT
-----------------------------------------------------
Name | CHRISTINE TROTTA
-----------------------------------------------------
Credential | PA
-----------------------------------------------------
Telephone | 434-566-8829
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | PA4288
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------