Provider Demographics
NPI:1437649647
Name:LIVINGSTONE, JOHN PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:LIVINGSTONE
Suffix:
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 1:154 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2725
Mailing Address - Country:US
Mailing Address - Phone:781-430-8161
Mailing Address - Fax:781-430-8191
Practice Address - Street 1:154 GREAT RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2725
Practice Address - Country:US
Practice Address - Phone:781-430-8161
Practice Address - Fax:781-430-8191
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3570363A00000X
MAPA8005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3570OtherTN PA LICENSE NUMBER
MAPA8005OtherMA PA LICENSE NUMBER