Provider Demographics
NPI:1942641816
Name:PASTOR, KELLY ANNE (PA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:PASTOR
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:46B DOMINION RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2367
Mailing Address - Country:US
Mailing Address - Phone:508-450-3922
Mailing Address - Fax:
Practice Address - Street 1:101 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3766
Practice Address - Country:US
Practice Address - Phone:781-272-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2016-03-28
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant