Individual
STEPHANIE C. MAYBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-3452
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA05684
TX
363A00000X
Physician Assistant
PA20096
CA
363A00000X
Physician Assistant
Primary
PA5002
MA
Other
Enumeration date
05/09/2008
Last updated
11/05/2020
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