Provider Demographics
NPI:1649379579
Name:SARAGOSA, KATHERINE SARAH (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SARAH
Last Name:SARAGOSA
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 1:802 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2708
Mailing Address - Country:US
Mailing Address - Phone:781-662-8881
Mailing Address - Fax:781-662-8886
Practice Address - Street 1:802 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2708
Practice Address - Country:US
Practice Address - Phone:781-662-8881
Practice Address - Fax:781-662-8886
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA1306363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical