Healthcare Provider Details

I. General information

NPI: 1326401811
Provider Name (Legal Business Name): AMINA ANN CARTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 ALBANY AVENUE
HARTFORD CT
06112-2132
US

IV. Provider business mailing address

345 WHITNEY AVENUE
NEW HAVEN CT
06511-2348
US

V. Phone/Fax

Practice location:
  • Phone: 860-728-0203
  • Fax: 860-728-0234
Mailing address:
  • Phone: 203-752-2856
  • Fax: 203-752-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003517
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: