Provider Demographics
NPI:1245781467
Name:ZUPAN, PATRICIA JACQUELYN (PA - C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JACQUELYN
Last Name:ZUPAN
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NEW HAMPSHIRE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2864
Mailing Address - Country:US
Mailing Address - Phone:603-319-6223
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:236 COCHITUATE RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4627
Practice Address - Country:US
Practice Address - Phone:774-244-3227
Practice Address - Fax:774-244-4916
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020125363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPA8099OtherMA STATE LICENSE
NY020125OtherNY STATE LICENSE