Provider Demographics
NPI:1821085945
Name:DYBALA, MICHELLE L (PA)
Entity Type:Individual
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First Name:MICHELLE
Middle Name:L
Last Name:DYBALA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:370 FAUNCE CORNER RD
Mailing Address - Street 2:SOUTHCOAST PRIMARY CARE INC
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1271
Mailing Address - Country:US
Mailing Address - Phone:508-985-2000
Mailing Address - Fax:508-985-2001
Practice Address - Street 1:109 FAIRHAVEN RD
Practice Address - Street 2:SOUTHCOAST PRIMARY CARE INC
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-1459
Practice Address - Country:US
Practice Address - Phone:508-758-3781
Practice Address - Fax:508-758-4455
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA1579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant