Provider Demographics
NPI:1992302897
Name:POND, MARISSA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:MARISSA
Middle Name:
Last Name:POND
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 1:95 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2809
Mailing Address - Country:US
Mailing Address - Phone:978-382-3828
Mailing Address - Fax:
Practice Address - Street 1:95 CONCORD ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2809
Practice Address - Country:US
Practice Address - Phone:978-382-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant