Provider Demographics
NPI:1558404814
Name:BURDETSKY, MARGARITA G (PAC MS)
Entity Type:Individual
Prefix:MS
First Name:MARGARITA
Middle Name:G
Last Name:BURDETSKY
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Gender:F
Credentials:PAC MS
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Mailing Address - Street 1:CHA-EVERETT FAMILY HEALTH CENTER
Mailing Address - Street 2:391 BROADWAY
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149
Mailing Address - Country:US
Mailing Address - Phone:617-389-0045
Mailing Address - Fax:
Practice Address - Street 1:391 BROADWAY STE 204
Practice Address - Street 2:PROHEALTH INTAGRATED MEDICAL
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3471
Practice Address - Country:US
Practice Address - Phone:617-389-0045
Practice Address - Fax:617-389-1619
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2015-07-28
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Provider Licenses
StateLicense IDTaxonomies
MAPA5063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant