Provider Demographics
NPI:1922575406
Name:BERUBE, EIKATARINE T (PA-C)
Entity type:Individual
Prefix:
First Name:EIKATARINE
Middle Name:T
Last Name:BERUBE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EIKATARINE
Other - Middle Name:
Other - Last Name:LAMPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:33 BARTLETT ST STE 206
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1317
Mailing Address - Country:US
Mailing Address - Phone:978-458-1293
Mailing Address - Fax:978-458-6953
Practice Address - Street 1:33 BARTLETT ST STE 206
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1317
Practice Address - Country:US
Practice Address - Phone:978-458-1293
Practice Address - Fax:978-458-6953
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6931363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110150594AMedicaid