Provider Demographics
NPI:1568707826
Name:FIORE, COURTNEY BETH (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:BETH
Last Name:FIORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:BETH
Other - Last Name:ATKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:147 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-2446
Mailing Address - Country:US
Mailing Address - Phone:401-575-8277
Mailing Address - Fax:
Practice Address - Street 1:45 FRANCIS ST
Practice Address - Street 2:ASBII-3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6105
Practice Address - Country:US
Practice Address - Phone:617-732-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4510363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA2742460OtherDEA CONTROLLED SUBSTANCE REGISTRATION