Provider Demographics
NPI:1982317681
Name:FIORENTINO, COLIN P (PA-C)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:P
Last Name:FIORENTINO
Suffix:
Gender:
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 1:711 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1542
Mailing Address - Country:US
Mailing Address - Phone:508-583-1100
Mailing Address - Fax:508-583-1120
Practice Address - Street 1:711 W CENTER ST
Practice Address - Street 2:
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1542
Practice Address - Country:US
Practice Address - Phone:508-775-8282
Practice Address - Fax:508-775-8280
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA100525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA390200000XMedicaid