MEDICARE: DEANNA L. KARDOOS 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
1	363A00000X	Physician Assistant	PA778	MA

General Provider Information

NPI Number	:	1386693885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA L. KARDOOS PA-C

Provider Business Mailing Address
First Line	:	190 GROTON RD
Second Line	:
City	:	AYER
State	:	MA
Zip	:	01432-1124
Country	:	US
Telephone Number	:	978-772-2780
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 GROTON RD
Second Line	:
City	:	AYER
State	:	MA
Zip	:	01432-1124
Country	:	US
Telephone Number	:	978-772-2780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	05/15/2026

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