Provider Demographics
NPI:1326012345
Name:FORTIER, NATASHA M (PA-C)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:M
Last Name:FORTIER
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:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:119 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2903
Practice Address - Country:US
Practice Address - Phone:508-334-8515
Practice Address - Fax:508-334-6490
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00367363AM0700X
MAPA3975363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004092Medicaid
RI30-00449OtherEVERCARE(UHC)
RI979004092Medicare ID - Type Unspecified
RI000296205OtherBC/BS OF RI
RI412662OtherBLUECHIP OF RI(BC/BS 0
Q45625Medicare UPIN