Healthcare Provider Details

I. General information

NPI: 1700256187
Provider Name (Legal Business Name): MARYKATE BAXTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY-KATE ALMEIDA

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HARTFORD HEALTHCARE-CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-4166
  • Fax: 860-545-0500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3460
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: