Provider Demographics
NPI:1639281819
Name:NOPNIRAPATH, WERA (LICAC, MAOM)
Entity Type:Individual
Prefix:MR
First Name:WERA
Middle Name:
Last Name:NOPNIRAPATH
Suffix:
Gender:M
Credentials:LICAC, MAOM
Other - Prefix:MR
Other - First Name:MINT
Other - Middle Name:
Other - Last Name:NOPNIRAPATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICAC, MAOM
Mailing Address - Street 1:23 ELM ST
Mailing Address - Street 2:APT 308
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2259
Mailing Address - Country:US
Mailing Address - Phone:617-623-8763
Mailing Address - Fax:617-623-8763
Practice Address - Street 1:9 MERIAM ST
Practice Address - Street 2:SUITE 16
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-5300
Practice Address - Country:US
Practice Address - Phone:781-325-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221049171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist