Provider Demographics
NPI:1275294720
Name:THEODHORAQI, GLORIANNA ATHINA (PA)
Entity Type:Individual
Prefix:
First Name:GLORIANNA
Middle Name:ATHINA
Last Name:THEODHORAQI
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:123 SUMMER ST STE 675
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 SUMMER ST STE 675
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-948-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2023-07-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant