Individual
ERICA CORDELLE THIBEAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-7648
Mailing address
47 COLBORNE RD APT B2, BRIGHTON, MA 02135-4112
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA6205
MA
Other
Enumeration date
09/15/2017
Last updated
09/15/2017
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