Provider Demographics
NPI:1568404952
Name:BOLOGNESE, SHERRI (PA)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:BOLOGNESE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:
Other - Last Name:BEALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6278
Mailing Address - Country:US
Mailing Address - Phone:978-521-3270
Mailing Address - Fax:978-469-5656
Practice Address - Street 1:1 PARKWAY
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6278
Practice Address - Country:US
Practice Address - Phone:978-521-3270
Practice Address - Fax:978-469-5656
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2082363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP267402Medicare PIN
MAAP267401Medicare PIN