Provider Demographics
NPI:1952357105
Name:PILGRIM, CAROL REGINA (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:REGINA
Last Name:PILGRIM
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Gender:F
Credentials:APRN, BC
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Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER, SHAPIRO 9
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-9943
Mailing Address - Fax:617-667-1020
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER, SHAPIRO 9
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-9943
Practice Address - Fax:617-667-1020
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
MA259240-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0708721Medicaid