Provider Demographics
NPI:1174770754
Name:PAPPALARDO-RAYMOND, MARY (PNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:PAPPALARDO-RAYMOND
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:P
Other - Last Name:PAPPALARDO RAYMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7 ALFRED ST
Mailing Address - Street 2:BALWIN PARK II
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1976
Mailing Address - Country:US
Mailing Address - Phone:781-933-6236
Mailing Address - Fax:781-938-8050
Practice Address - Street 1:7 ALFRED ST
Practice Address - Street 2:BALWIN PARK II
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1976
Practice Address - Country:US
Practice Address - Phone:781-933-6236
Practice Address - Fax:781-938-8050
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168304363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics