Basic Information
Provider Information | |||||||||
NPI: | 1861425803 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PILAND | ||||||||
FirstName: | ANTHONY | ||||||||
MiddleName: | DURAND | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | SR. | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 HOSPITAL RD | ||||||||
Address2: |   | ||||||||
City: | OAK BLUFFS | ||||||||
State: | MA | ||||||||
PostalCode: | 025571406 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5086844500 | ||||||||
FaxNumber: | 5086844502 | ||||||||
Practice Location | |||||||||
Address1: | 1 HOSPITAL RD | ||||||||
Address2: |   | ||||||||
City: | OAK BLUFFS | ||||||||
State: | MA | ||||||||
PostalCode: | 025571406 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5086844500 | ||||||||
FaxNumber: | 5086844502 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/09/2006 | ||||||||
LastUpdateDate: | 08/30/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/30/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 2559 | MA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
ID | Type | State | Issuer | Description | S400258225 | 01 | MA | MEDICARE | OTHER | 110107364A | 05 | MA |   | MEDICAID |