Basic Information
| Provider Information | |||||||||
| NPI: | 1043941784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | GINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38A CRESCENT ST | ||||||||
| Address2: | |||||||||
| City: | WEST NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024652021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174176303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 43 FOUNDRY AVE | ||||||||
| Address2: | |||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024538313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816933800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2022 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.