Provider Demographics
NPI:1013028430
Name:SOONTHORNPRAPUET, PATRICIA O'HEARN (PA-C, MPH)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:O'HEARN
Last Name:SOONTHORNPRAPUET
Suffix:
Gender:F
Credentials:PA-C, MPH
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Mailing Address - Street 1:20 SLAVIN DR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-3278
Mailing Address - Country:US
Mailing Address - Phone:603-953-3573
Mailing Address - Fax:
Practice Address - Street 1:1400 VFW PKWY
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4927
Practice Address - Country:US
Practice Address - Phone:617-323-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA568363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant