MRS. MAUREEN PENDERGAST FULLER (NPI# 1558306209) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558306209 |
| Entity Type | Individual |
| Full Name | MRS. MAUREEN PENDERGAST FULLER |
| Credential | P.A. |
| Practice Address |
85 South St Ware MA 01082-1625 |
| Mailing Address |
5220 Belfort Rd Ste 130 Jacksonville FL 32256-6018 |
| Practice Telephone | 4139672268 |
| Practice Fax Number | 4139672548 |
| Mailing Telephone | 9044463686 |
| Mailing Fax Number | 9044463032 |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2020-09-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 1366 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | BCBS | M15170 | 01 |
| Street Address |
85 SOUTH ST |
| City | WARE |
| State | MA |
| Zip Code | 01082-1625 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144221847 | Baystate Mary Lane Hospital Corporation | Clinic/Center | 85 South St, Ware, MA 01082-1625 | 2005-08-03 |
| 1316429095 | Anzhela Savonina | Registered Nurse | 85 South St, Ware, MA 01082-1625 | 2018-08-30 |
| 1538576293 | Miah Digregorio | Physician Assistant | 85 South St, Ware, MA 01082-1625 | 2014-07-15 |
| 1558623777 | Cogent Healthcare of Brockton PC | Hospitalist | 85 South St, Ware, MA 01082-1625 | 2012-06-13 |
| 1922301779 | Baystate Medical Center, Inc. | Durable Medical Equipment & Medical Supplies | 85 South St, Room D101, Ware, MA 01082-1625 | 2010-12-17 |
| 1093900706 | Harshad V. Sanghvi, Md, PC | Spec/Tech, Cardiovascular | 85 South St, Suite 7, Ware, MA 01082-1625 | 2007-09-06 |
| 1962521104 | William Scott King | Physician Assistant | 85 South St, Suite 8, Ware, MA 01082-1667 | 2007-03-28 |
| 1518083518 | Jane Victoria Harper | Nurse Practitioner | 85 South St, Ware, MA 01082-1667 | 2007-03-21 |
| 1184756579 | South Central Surgical Center | Surgery | 85 South St, Ware, MA 01082-1667 | 2007-03-12 |
| 1356478168 | David I Miller | Emergency Medicine | 85 South St, Ware, MA 01082-1667 | 2007-02-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386957348 | Hakim & Safi, M.d.'s LLC | Internal Medicine | 83 South Street, Suite 2, Ware, MA 01082 | 2010-07-20 |
| 1295924165 | John Richard Weise | Licensed Practical Nurse | 99 Church Street, Ware, MA 01082 | 2007-10-17 |
| 1790973295 | Patricia Ann Hempel | Counselor | 96 South St., Ware, MA 01082 | 2007-10-09 |
| 1124090741 | Herbert Ira Cohen | Dentist | 173 West St, Ware, MA 01082 | 2006-02-07 |
| 1972052892 | Nicholle Blaine | Counselor | 76 Main Street, Ware, MA 01082 | 2016-10-04 |
| 1174940175 | Kimberly A Marakovits | Obstetrics & Gynecology | 83 South Street, Suite 111, Ware, MA 01082 | 2014-03-27 |
| 1033432851 | Nora Lynn Holland | Registered Nurse | 75 Maple St, Ware, MA 01082 | 2010-03-08 |
| 1851466254 | Robert W Shamey | Dentist | 244 West Street, Ware, MA 01082-0060 | 2006-11-21 |
| 1114034253 | Daniel Gerard Berneche | Chiropractor | 246 West Street, Ware, MA 01082-0628 | 2006-08-24 |
| 1710437959 | Brooke Bergeron | Counselor | 102 Pleasant St, Ware, MA 01082-1023 | 2016-10-12 |
| Find all providers in zip 01082 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538576293 | Miah Digregorio | Physician Assistant | 85 South St, Ware, MA 01082-1625 | 2014-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548869274 | David M Correll | Physician Assistant | 45 Wollaston Ave, Arlington, MA 02476-5836 | 2020-10-23 |
| 1699374660 | Sarah Ilana Katz | Physician Assistant | 11a Laurel St, Salem, MA 01970-4657 | 2020-10-21 |
| 1205435393 | Allison Lee Nocon | Physician Assistant | 289 Beacon St Apt 8, Boston, MA 02116-1263 | 2020-10-20 |
| 1841898384 | Chloe Friedman | Physician Assistant | 62 Patricia Dr, Abington, MA 02351-1081 | 2020-10-16 |
| 1760080378 | Jason Lee | Physician Assistant | 42 Electric Ave, Somerville, MA 02144-1604 | 2020-10-15 |
| 1700484656 | Emily Cioffi | Physician Assistant | 5 Cosma Rd, North Easton, MA 02356-1331 | 2020-10-13 |
| 1407453806 | Emily Louis | Physician Assistant | 174 Groton Rd, North Chelmsford, MA 01863-1205 | 2020-10-08 |
| 1336746775 | Lee T Gernon-lakin | Physician Assistant | 202 Robinson Hall, 360 Huntington Ave, Boston, MA 02215 | 2020-10-08 |
| 1073110433 | Ellen Boyle | Physician Assistant | 11 Castle Gate Rd, Wayland, MA 01778-4310 | 2020-10-07 |
| 1992302897 | Marissa Pond | Physician Assistant | 95 Concord St, Haverhill, MA 01830-2809 | 2020-10-04 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MRS. MAUREEN PENDERGAST FULLER.
| 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.