Provider Demographics
NPI:1164949335
Name:CURIEL ROSA, WILTON (PA)
Entity Type:Individual
Prefix:
First Name:WILTON
Middle Name:
Last Name:CURIEL ROSA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:WILTON
Other - Middle Name:
Other - Last Name:CURIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:55 FRUIT STREET WHITE 1
Mailing Address - Street 2:WHITE 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-724-4100
Mailing Address - Fax:617-726-7415
Practice Address - Street 1:175 S WILKES BARRE BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3838
Practice Address - Country:US
Practice Address - Phone:570-829-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7448363A00000X
363A00000X
PAMA059481363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant