Provider Demographics
NPI:1629562814
Name:RONZIO, CLARISSA GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:GRACE
Last Name:RONZIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-3329
Mailing Address - Country:US
Mailing Address - Phone:978-886-6005
Mailing Address - Fax:
Practice Address - Street 1:SAINT ELIZABETH'S MEDICAL CENTER
Practice Address - Street 2:736 CAMBRIDGE ST
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-0213
Practice Address - Country:US
Practice Address - Phone:978-866-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA6588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant