Provider Demographics
NPI:1851354989
Name:BUONANNO, MARGARET R (PA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:R
Last Name:BUONANNO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:BUONANNO
Other - Last Name:AGUILERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12 RICKER RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2127
Mailing Address - Country:US
Mailing Address - Phone:617-969-0806
Mailing Address - Fax:
Practice Address - Street 1:450 BROOKLINE AVE # D3125
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-582-8032
Practice Address - Fax:617-632-1990
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1864363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ47217Medicare UPIN