Provider Demographics
NPI:1962691386
Name:DEIGNAN, GINA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:DEIGNAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:SCHEID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:LAHEY HOSPITAL AND MEDICAL CENTER
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8460
Mailing Address - Fax:781-744-5261
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-1718
Practice Address - Country:US
Practice Address - Phone:781-744-8460
Practice Address - Fax:781-744-5261
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant