Provider Demographics
NPI:1063539971
Name:EGBERTSON, JOY (PA)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:EGBERTSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:695 TRUMAN PKWY
Mailing Address - Street 2:SUITE #203
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136
Mailing Address - Country:US
Mailing Address - Phone:617-361-1470
Mailing Address - Fax:617-361-9060
Practice Address - Street 1:695 TRUMAN HWY
Practice Address - Street 2:SUITE #203
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3552
Practice Address - Country:US
Practice Address - Phone:617-361-1470
Practice Address - Fax:617-361-9060
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant