Individual
PAUL KETRO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
425 REVERE ST, ELL POND MEDICAL ASSOCIATES INC, REVERE, MA 02151-4543
(781) 286-1313
(781) 286-1098
Mailing address
425 REVERE ST, ELL POND MEDICAL ASSOCIATES INC ATTN JUNE VINARD, REVERE, MA 02151-4543
(781) 286-1313
(781) 286-1098
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
77202
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3112004
—
MA
Enumeration date
11/21/2005
Last updated
07/08/2007
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