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General NPI Number Information
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NPI Number | 1427618727
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Entity Type | Individual
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Provider Name | MICHELLE VIDAL PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 3 WASHINGTON ST STE 200
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City | NORTH EASTON
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State | MA
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Zip | 02356-1034
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Country | US
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Telephone | 617-480-3188
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Fax |
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Provider Business Mailing Address
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Address Line | 23 PINE ST UNIT D
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City | CANTON
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State | MA
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Zip | 02021-3346
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Country | US
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Telephone | 617-480-3188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA7369
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License Number State | MA
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