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Individual

MICHELLE EJIOFOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
680 CENTRE ST, BROCKTON, MA 02302-3308
(717) 222-8138
Mailing address
110 LIBERTY ST, BROCKTON, MA 02301-5674
(508) 565-3055

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
C0004561
MD
363AS0400X
Surgical Physician Assistant
Primary
PA4550
MA

Other

Enumeration date
11/01/2011
Last updated
01/22/2021
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