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NPI Code Detail

MEDICARE: EKATERINA V REVIN PA-C

MEDICARE: EKATERINA V REVIN 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 Assistant2088NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326661927
Entity Type Code : Individual
Provider Name (Legal Business Name) : EKATERINA V REVIN PA-C
Provider Business Mailing Address
First Line : 7 PORTWALK PL UNIT 1414
Second Line :
City : PORTSMOUTH
State : NH
Zip : 03801-7008
Country : US
Telephone Number : 774-521-2157
Fax Number :
Provider Business Practice Location Address
First Line : 10 MEMBERS WAY STE 300
Second Line :
City : DOVER
State : NH
Zip : 03820-5933
Country : US
Telephone Number : 603-749-0913
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2020
Last Update Date : 01/28/2026

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Directions to “ EKATERINA V REVIN PA-C” Practice Location

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