Provider Demographics
NPI:1679244602
Name:REVERDY, ELENA ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:ROSE
Last Name:REVERDY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:18 PLEASANT ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3344
Mailing Address - Country:US
Mailing Address - Phone:978-793-9671
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST # STREET1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-4100
Practice Address - Fax:617-726-7415
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-11-09
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant