Provider Demographics
NPI:1619978988
Name:VALDEZ, MIGUEL V (MS PAC)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:V
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:MS PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 MASSACHUSETTS AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:N ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4143
Mailing Address - Country:US
Mailing Address - Phone:978-685-7550
Mailing Address - Fax:978-686-5565
Practice Address - Street 1:198 MASSACHUSETTS AVE
Practice Address - Street 2:STE 103
Practice Address - City:N ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-4143
Practice Address - Country:US
Practice Address - Phone:978-685-7550
Practice Address - Fax:978-686-5565
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1339363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1339OtherMA LICENSE
1339OtherMA LICENSE
1339OtherMA LICENSE