Provider Demographics
NPI:1598742462
Name:PAPPALARDO, EILEEN (NP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:PAPPALARDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:PAPPALARDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:177 TREMONT ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1020
Mailing Address - Country:US
Mailing Address - Phone:617-542-2200
Mailing Address - Fax:617-553-1976
Practice Address - Street 1:177 TREMONT ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1020
Practice Address - Country:US
Practice Address - Phone:617-542-2200
Practice Address - Fax:617-553-1976
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA94955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9785639Medicaid
MANP3912Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
MA9785639Medicaid