Provider Demographics
NPI:1700859212
Name:MACGILLIVRAY, JANICE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:MACGILLIVRAY
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 1:48 PARTRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3010
Mailing Address - Country:US
Mailing Address - Phone:617-469-2050
Mailing Address - Fax:
Practice Address - Street 1:7 HAVILAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-2683
Practice Address - Country:US
Practice Address - Phone:617-927-6100
Practice Address - Fax:617-247-3460
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1707363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical