Provider Demographics
NPI:1891910352
Name:GOETZ, MARGARETHE E (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARGARETHE
Middle Name:E
Last Name:GOETZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:SICU-STROKE STEPDOWN PROGRAM
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-856-4050
Practice Address - Fax:508-856-1060
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2009-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0008058Medicare PIN