Provider Demographics
NPI:1740282730
Name:PETERS-GILMARTIN, JOAN A (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:A
Last Name:PETERS-GILMARTIN
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 1:81 OLD COLONY WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-3278
Mailing Address - Country:US
Mailing Address - Phone:508-240-1141
Mailing Address - Fax:508-240-3031
Practice Address - Street 1:81 OLD COLONY WAY
Practice Address - Street 2:SUITE D
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3278
Practice Address - Country:US
Practice Address - Phone:508-240-1141
Practice Address - Fax:508-240-3031
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA708363A00000X
MAPA708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S81129Medicare UPIN
GIAP1051Medicare ID - Type Unspecified