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1093201667
MATTHEW JACOB DACOSTA
PROVIDENCE, RI
NPI
1093201667
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: RI PA01269)
Enumeration Date
2018-07-07
Last Update Date
2020-10-23
Business Address
MATTHEW JACOB DACOSTA PA-C
180 CORLISS ST STE B
PROVIDENCE, RI 02904-2602
Phone number: 401-793-8400
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Mailing Address
MATTHEW JACOB DACOSTA PA-C
111 FRANKLIN ST APT 2
BRISTOL, RI 02809-2327
Phone number: 508-264-1979
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