Basic Information
Provider Information
NPI: 1336265909
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABATE
FirstName: PAULA
MiddleName: M
NamePrefix: MS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 415348
Address2:  
City: BOSTON
State: MA
PostalCode: 022415348
CountryCode: US
TelephoneNumber: 8002258885
FaxNumber: 5083341977
Practice Location
Address1: 55 LAKE AVE N
Address2: DEPARTMENT OF PEDIATRIC NEUROLOGY
City: WORCESTER
State: MA
PostalCode: 016550002
CountryCode: US
TelephoneNumber: 7744418084
FaxNumber: 5088564287
Other Information
ProviderEnumerationDate: 03/22/2007
LastUpdateDate: 11/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XRN141008MAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
363L00000XRN141008MAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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