Basic Information
| Provider Information | |||||||||
| NPI: | 1609934140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CURTIS | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. -C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 FRANCIS ST STE 2A | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176328383 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 330 BROOKLINE AVE # SHAPIRO7 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176678800 | ||||||||
| FaxNumber: | 9496501274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 06/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA18172 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 330204983 0048 | 01 | CA | CIGNA GROUP NUMBER | OTHER | PA17172 | 01 | CA | CA LICENSE | OTHER | 330204983 | 01 | CA | TAX ID | OTHER | 330204983 0039 | 01 | CA | CIGNA GROUP NUMBER | OTHER | YYY49979Y | 01 | CA | BLUE SHIELD | OTHER | 0000000135 | 01 | CA | GNP GROUP NUMBER | OTHER | 019023 | 01 | CA | GNP | OTHER | 1750339479 | 01 | CA | NPI GROUP NUMBER | OTHER | GR002729 | 05 | CA | MEDICAID |