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NPI Code Detail

MEDICARE: JUSTINE JOANN VITETTA PA-C

MEDICARE: JUSTINE JOANN VITETTA PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA9397MA
2363AM0700XMedical Physician Assistant

General Provider Information

NPI Number : 1033666284
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTINE JOANN VITETTA PA-C
Provider Business Mailing Address
First Line : PO BOX 415348
Second Line :
City : BOSTON
State : MA
Zip : 02241-5348
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 55 LAKE AVE N
Second Line :
City : WORCESTER
State : MA
Zip : 01655-0002
Country : US
Telephone Number : 508-334-2128
Fax Number : 774-443-2043
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2016
Last Update Date : 03/26/2026

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Directions to “ JUSTINE JOANN VITETTA PA-C” Practice Location

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