Provider Demographics
NPI:1124049069
Name:FIGUEIREDO, MARISA (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARISA
Middle Name:
Last Name:FIGUEIREDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375A HARVARD ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4122
Mailing Address - Country:US
Mailing Address - Phone:617-232-9500
Mailing Address - Fax:857-364-4179
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:MS GI III
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:617-705-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1173363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1173OtherPHYSICIAN ASSIST LICENSE