Provider Demographics
NPI:1144200452
Name:WATERMAN, ROSEMARY C (PA)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:C
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 PLEASANT ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:781-322-3005
Mailing Address - Fax:781-322-1394
Practice Address - Street 1:380 PLEASANT ST
Practice Address - Street 2:SUITE 13
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148
Practice Address - Country:US
Practice Address - Phone:781-322-3005
Practice Address - Fax:781-322-1394
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA380363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP0048Medicare ID - Type Unspecified