Provider Demographics
NPI:1932892098
Name:PENTA, ANTONIA XENIA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:XENIA
Last Name:PENTA
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 1:7 BURDITT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1711
Practice Address - Country:US
Practice Address - Phone:978-922-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant