Healthcare Provider Details

I. General information

NPI: 1093292310
Provider Name (Legal Business Name): PHYSICIANS ALLIANCE OF CONNECTICUT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 GOOSE LN STE 203B
GUILFORD CT
06437-2158
US

IV. Provider business mailing address

322 E MAIN ST STE 1B
BRANFORD CT
06405-3136
US

V. Phone/Fax

Practice location:
  • Phone: 203-408-2700
  • Fax: 203-884-8201
Mailing address:
  • Phone: 203-488-7228
  • Fax: 203-488-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: YVETTE BARCHAT
Title or Position: COO
Credential:
Phone: 203-488-7228