Provider Demographics
NPI:1578702197
Name:KETCHUM, ROBERT S (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:KETCHUM
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:370 FAUNCE CORNER ROAD
Mailing Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC.
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1271
Mailing Address - Country:US
Mailing Address - Phone:508-985-2000
Mailing Address - Fax:508-985-2001
Practice Address - Street 1:101 PAGE STREET
Practice Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC.
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3464
Practice Address - Country:US
Practice Address - Phone:508-961-5919
Practice Address - Fax:508-961-5916
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2010-08-02
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Provider Licenses
StateLicense IDTaxonomies
MAPA3993363A00000X
NY013121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant