RANDY WIDTFELDT (NPI# 1487089504) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487089504 |
| Entity Type | Individual |
| Full Name | RANDY WIDTFELDT |
| Credential | PA |
| Practice Address |
405 Pearl St Malden MA 02148-6644 |
| Mailing Address |
92 Montvale Ave Ste 1400 Stoneham MA 02180-3629 |
| Practice Telephone | 7816659500 |
| Practice Fax Number | 7816653856 |
| Mailing Telephone | 7812797040 |
| Mailing Fax Number | 7812798430 |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2017-02-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA4822 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
405 PEARL ST |
| City | MALDEN |
| State | MA |
| Zip Code | 02148-6644 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154378479 | Evan J. Zahner | Orthopaedic Surgery | 405 Pearl St, Malden, MA 02148-6644 | 2006-05-30 |
| 1487105250 | Gregory Malvey | Physician Assistant | 405 Pearl St, Malden, MA 02148-6644 | 2016-10-17 |
| 1366999351 | Emily Smalheiser | Physical Therapist | 405 Pearl St, Malden, MA 02148-6644 | 2016-09-07 |
| 1023496551 | Angela Lynn Peterson | Physical Therapist | 405 Pearl St, Malden, MA 02148-6644 | 2015-05-17 |
| 1528498664 | Adam Izzicupo | Physical Therapist | 405 Pearl St, Suite 2, Malden, MA 02148-6644 | 2013-11-26 |
| 1962774638 | Middlesex Recovery Professional Corporation | Family Medicine | 405 Pearl St, Suite 4, Malden, MA 02148-6644 | 2012-01-27 |
| 1710278122 | Robert Hurley | Physical Therapist | 405 Pearl St, Malden, MA 02148-6644 | 2011-04-20 |
| 1417270224 | Raquel Silva Depaula | Physical Therapist | 405 Pearl St, Malden, MA 02148-6644 | 2010-03-08 |
| 1841425634 | Jessica Lynn Thomas | Physical Therapist | 405 Pearl St, Malden, MA 02148-6644 | 2009-05-21 |
| 1639366776 | North Suburban Orthopedic Associates Inc | Physical Therapist | 405 Pearl St, Malden, MA 02148-6644 | 2007-10-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427680743 | Cambridge Public Health Commission | Pharmacy | 350 Main Street Suite 640, Malden, MA 02148 | 2020-02-05 |
| 1568932192 | Stephanie L Octave | Behavior Technician | 28 Wolcott St, Malden, MA 02148 | 2018-11-27 |
| 1477036549 | Fabienne Odney | Registered Nurse | 41 Alpine St, Malden, MA 02148 | 2018-09-13 |
| 1972085322 | Donna Watson | Social Worker | 33 Goodwin Avenue, Malden, MA 02148 | 2018-09-02 |
| 1588144505 | Michael William Sage | Physician Assistant | Cha Malden Care Center, 195 Canal Street, Malden, MA 02148 | 2018-08-20 |
| 1255827432 | Martineau Louine | Internal Medicine | 11 Dennis Road, Malden, MA 02148 | 2018-07-10 |
| 1700378098 | Catherine Grieves | Social Worker | 785 Main St Apt. 6, Malden, MA 02148 | 2018-06-01 |
| 1215427901 | Leam Thomas | Counselor | 175 Summer Street, Apt204, Malden, MA 02148 | 2018-05-17 |
| 1629593637 | David Acuna | Counselor | 22 Plesant Street, Malden, MA 02148 | 2017-08-10 |
| 1295258580 | Judith P Phillips | Physician Assistant | 24 Auburn Street, Malden, MA 02148 | 2017-07-19 |
| Find all providers in zip 02148 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023627106 | Taia Maria Tieland | Physician Assistant | 9 Hunting St Apt 1, Cambridge, MA 02141-1010 | 2020-07-24 |
| 1003434275 | Antonious Jonah Abraham | Physician Assistant | 99 Corn Rd, Bolton, MA 01740-1055 | 2020-07-13 |
| 1407479272 | Mackenzie Malcolm Gray | Physician Assistant | 35 Pynchon Rd, Holyoke, MA 01040-1514 | 2020-05-27 |
| 1780235333 | Emily Fregeau | Physician Assistant | 1 Canal St Unit 518, Boston, MA 02114-2053 | 2019-09-25 |
| 1992369524 | Jaclyn Hynes | Physician Assistant | 234 Otis St, Hingham, MA 02043-4504 | 2019-04-29 |
| 1376002931 | Jack City, LLC | Physician Assistant | 290 Pleasant St Apt 212, Watertown, MA 02472-2429 | 2019-03-13 |
| 1578021911 | Ashley Piemonte | Physician Assistant | 15 1/2 Russell St Apt 1, Charlestown, MA 02129-2492 | 2019-03-05 |
| 1407323686 | Nicole Burke Tingley | Physician Assistant | 123 Summer St Ste 277, Worcester, MA 01608-1216 | 2018-10-25 |
| 1386111706 | Nicole Laura Solman | Physician Assistant | 16 Deerhaven Rd, Lincoln, MA 01773-1806 | 2018-10-24 |
| 1881160943 | Philip Apraku Bondzie | Physician Assistant | 266 Sportsmans Trl, Whitman, MA 02382-1726 | 2018-10-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.