Provider Demographics
NPI:1710207980
Name:MARUCA, JESSICA M (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:MARUCA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:M
Other - Last Name:FERRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:725 CONCORD AVE
Mailing Address - Street 2:STE 2100
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1040
Mailing Address - Country:US
Mailing Address - Phone:617-354-6552
Mailing Address - Fax:617-354-0222
Practice Address - Street 1:725 CONCORD AVE
Practice Address - Street 2:STE 2100
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1040
Practice Address - Country:US
Practice Address - Phone:617-354-6552
Practice Address - Fax:617-354-0222
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA3961363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0016115Medicare PIN