Provider Demographics
NPI:1386693885
Name:KARDOOS, DEANNA (PA-C)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:KARDOOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:DOUCETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:190 GROTON RD
Mailing Address - Street 2:
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1124
Mailing Address - Country:US
Mailing Address - Phone:978-772-2780
Mailing Address - Fax:
Practice Address - Street 1:190 GROTON RD
Practice Address - Street 2:
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1124
Practice Address - Country:US
Practice Address - Phone:978-772-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP0285Medicare PIN
MAS27587Medicare UPIN