Provider Demographics
NPI:1235223587
Name:DUCZAKOWSKI, ANGELICA FRANCINE (PA)
Entity Type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:FRANCINE
Last Name:DUCZAKOWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2 POND PARK RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4309
Mailing Address - Country:US
Mailing Address - Phone:781-337-5555
Mailing Address - Fax:781-331-0300
Practice Address - Street 1:2 POND PARK RD
Practice Address - Street 2:STE. 102
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4309
Practice Address - Country:US
Practice Address - Phone:781-337-5555
Practice Address - Fax:781-331-0300
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1909363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP2502Medicare PIN
Q24074Medicare UPIN