Provider Demographics
NPI:1700873155
Name:MARCHETTI, PAULA JEAN (PAC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:MARCHETTI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:M
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6602 KNIGHTDALE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6526
Mailing Address - Country:US
Mailing Address - Phone:919-747-5210
Mailing Address - Fax:
Practice Address - Street 1:6602 KNIGHTDALE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6526
Practice Address - Country:US
Practice Address - Phone:919-747-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10298363A00000X
MDC01470208M00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC171899Medicare PIN
MDS69064Medicare UPIN