Provider Demographics
NPI:1336624626
Name:PALEN, NICHOLAS PAUL (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:PAUL
Last Name:PALEN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:12 COPE FARMS RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3153
Mailing Address - Country:US
Mailing Address - Phone:860-989-0550
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-3874
Practice Address - Fax:617-643-4085
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
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Provider Licenses
StateLicense IDTaxonomies
MAPA6772363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant