Provider Demographics
NPI:1790973527
Name:PEIXOTO, ELISSA SCHOTT
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:SCHOTT
Last Name:PEIXOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1148
Mailing Address - Country:US
Mailing Address - Phone:508-350-2150
Mailing Address - Fax:508-350-2151
Practice Address - Street 1:1 COMPASS WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1465
Practice Address - Country:US
Practice Address - Phone:508-350-2150
Practice Address - Fax:508-350-2151
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00453363A00000X, 363AS0400X
MAPA2425363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400149308Medicare PIN