Individual
VIDAL PRIMITERIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
25 MARSTON ST, SUITE 105, LAWRENCE, MA 01841-2310
(978) 258-1057
(978) 258-1520
Mailing address
25 MARSTON ST, SUITE 105, LAWRENCE, MA 01841-2310
(978) 258-1057
(978) 258-1520
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1813
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Y10064
—
MA
Enumeration date
01/17/2006
Last updated
09/10/2014
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