MEDICARE: BECKET L GRETEN-HARRISON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	3818	CT
2	363A00000X	Physician Assistant	3818	CT

General Provider Information

NPI Number	:	1144755067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKET L GRETEN-HARRISON PA-C

Provider Business Mailing Address
First Line	:	499 AMITY RD
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-1603
Country	:	US
Telephone Number	:	203-800-9877
Fax Number	:	203-836-3988

Provider Business Practice Location Address
First Line	:	499 AMITY RD
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-1603
Country	:	US
Telephone Number	:	203-886-9307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2017
Last Update Date	:	05/20/2026

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Directions to “ BECKET L GRETEN-HARRISON PA-C” Practice Location

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