Individual
THERESA FUKUDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
43 BOWDOIN ST APT 2F, BOSTON, MA 02114-4238
(802) 999-3882
Mailing address
43 BOWDOIN ST APT 2F, BOSTON, MA 02114-4238
(802) 999-3882
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092289
—
MA
Enumeration date
04/25/2019
Last updated
04/25/2019
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