Provider Demographics
NPI:1669668174
Name:MADJAROV, REBECCA JOY (PA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOY
Last Name:MADJAROV
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1400 VFW PARKWAY
Mailing Address - Street 2:MEDICINE DEPARTMENT 111
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132
Mailing Address - Country:US
Mailing Address - Phone:857-203-5729
Mailing Address - Fax:857-203-5549
Practice Address - Street 1:1400 VFW PKWY
Practice Address - Street 2:MEDICINE DEPARTMENT 111
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4927
Practice Address - Country:US
Practice Address - Phone:857-203-5729
Practice Address - Fax:857-203-5549
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2012-07-10
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Provider Licenses
StateLicense IDTaxonomies
MAPA3696363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical