Provider Demographics
NPI:1245781467
Name:ZUPAN, PATRICIA (PA - C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ZUPAN
Suffix:
Gender:F
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 1:1254 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4401
Mailing Address - Country:US
Mailing Address - Phone:508-283-9773
Mailing Address - Fax:
Practice Address - Street 1:1254 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4401
Practice Address - Country:US
Practice Address - Phone:508-283-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020125363A00000X
MAPA8099363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPA8099OtherMA STATE LICENSE
NY020125OtherNY STATE LICENSE