Provider Demographics
NPI:1306089495
Name:CLATER, PHILIP A (PA-C)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:CLATER
Suffix:
Gender:M
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 1:103 GARLAND ST
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5066
Mailing Address - Country:US
Mailing Address - Phone:617-665-1600
Mailing Address - Fax:617-665-1976
Practice Address - Street 1:103 GARLAND ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5066
Practice Address - Country:US
Practice Address - Phone:617-665-1600
Practice Address - Fax:617-665-1976
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA3753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001107402Medicare PIN