Individual
MARY CARLEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
800 WASHINGTON ST, BOX 1013, BOSTON, MA 02111-1552
(339) 927-0105
Mailing address
800 WASHINGTON ST, BOX 1013, BOSTON, MA 02111-1552
(339) 927-0105
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA5031
MA
Other
Enumeration date
07/02/2014
Last updated
07/02/2014
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