Provider Demographics
NPI:1437466802
Name:KANEV, TERESA MAYNE (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MAYNE
Last Name:KANEV
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 1:148 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7243
Mailing Address - Country:US
Mailing Address - Phone:508-746-5900
Mailing Address - Fax:508-747-2290
Practice Address - Street 1:148 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7243
Practice Address - Country:US
Practice Address - Phone:508-746-5900
Practice Address - Fax:508-747-2290
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4062363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical