Provider Demographics
NPI:1336337492
Name:POLICELLI, MARIA L (PT, PA-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:POLICELLI
Suffix:
Gender:F
Credentials:PT, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 MONTVALE AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3647
Mailing Address - Country:US
Mailing Address - Phone:781-279-7040
Mailing Address - Fax:
Practice Address - Street 1:92 MONTVALE AVE
Practice Address - Street 2:SUITE 1400
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3647
Practice Address - Country:US
Practice Address - Phone:781-279-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-13
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100609T363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical