Provider Demographics
NPI:1982655593
Name:STASKO, KARA PEARSON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:PEARSON
Last Name:STASKO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KARA
Other - Middle Name:MARIE
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:55 FRUIT ST # MGH
Mailing Address - Street 2:WHITE 270
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-8396
Mailing Address - Fax:617-726-4891
Practice Address - Street 1:55 FRUIT ST # MGH
Practice Address - Street 2:WHITE 270
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8396
Practice Address - Fax:617-726-4891
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH359889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPEAP2513Medicare ID - Type Unspecified
Q56287Medicare UPIN