Provider Demographics
NPI:1689153454
Name:TOBIN, MAEVE RIANE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MAEVE
Middle Name:RIANE
Last Name:TOBIN
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 1:140 COURTLAND ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1429
Mailing Address - Country:US
Mailing Address - Phone:978-994-7175
Mailing Address - Fax:
Practice Address - Street 1:333 SCHOOL ST STE 112A
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5336
Practice Address - Country:US
Practice Address - Phone:401-728-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-12
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01075207N00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology