Provider Demographics
NPI:1487318994
Name:WARGOVICH, MAIREAD CHRISTINA (NP)
Entity type:Individual
Prefix:
First Name:MAIREAD
Middle Name:CHRISTINA
Last Name:WARGOVICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BETH ISRAEL DEACONESS SPECIALTY GROUP
Mailing Address - Street 2:83 ROUTE 130
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02664-8710
Mailing Address - Country:US
Mailing Address - Phone:508-210-5920
Mailing Address - Fax:
Practice Address - Street 1:BETH ISRAEL DEACONESS SPECIALTY GROUP
Practice Address - Street 2:110 LONG POND ROAD
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-8710
Practice Address - Country:US
Practice Address - Phone:508-210-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2317676363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner