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Individual
MARYBETH GORETSKY
Active
Individual
MARYBETH GORETSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA001317L
PA
363AS0400X
Surgical Physician Assistant
MA001317L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA001417L
PA LICENSE NUMBER
PA
Enumeration date
04/19/2011
Last updated
12/21/2020
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