Healthcare Provider Details

I. General information

NPI: 1023005220
Provider Name (Legal Business Name): KARA M. PACELIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST RADIOLOGY DEPARTMENT
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

1000 ASYLUM AVE SUITE 3201E
HARTFORD CT
06105-1770
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4092
  • Fax:
Mailing address:
  • Phone: 860-525-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001005
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: