Provider Demographics
NPI:1437702123
Name:ABBIATI, MICALA M (PA-C)
Entity Type:Individual
Prefix:
First Name:MICALA
Middle Name:M
Last Name:ABBIATI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICALA
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 STILES RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52 STILES RD STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4807
Practice Address - Country:US
Practice Address - Phone:603-898-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1746363A00000X
OK3090363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant