Provider Demographics
NPI:1184853426
Name:CREEDON, JOSEPH FRANCIS JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:FRANCIS
Last Name:CREEDON
Suffix:JR
Gender:M
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 1:750 WASHINGTON STREET
Mailing Address - Street 2:TUFTS MEDICAL CENTER, DEPT OF EMERGENCY MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-4720
Mailing Address - Fax:617-636-4723
Practice Address - Street 1:750 WASHINGTON STREET
Practice Address - Street 2:TUFTS MEDICAL CENTER, DEPT OF EMERGENCY MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-4720
Practice Address - Fax:617-636-4723
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical