Provider Demographics
NPI:1639385131
Name:PINKHAM, AMY MEGGAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:MEGGAN
Last Name:PINKHAM
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 1:34 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-3191
Mailing Address - Country:US
Mailing Address - Phone:978-835-6212
Mailing Address - Fax:
Practice Address - Street 1:4 MAIN ST.
Practice Address - Street 2:APT. 2
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2109
Practice Address - Country:US
Practice Address - Phone:978-835-6212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP1964363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10074698OtherEMPLOYEE ID #
MAQ57576Medicare UPIN