Healthcare Provider Details

I. General information

NPI: 1831683523
Provider Name (Legal Business Name): TRISHA KOWALSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 LEWIS AVE
MERIDEN CT
06451
US

IV. Provider business mailing address

49 ORIENT ST
OAKVILLE CT
06779-1324
US

V. Phone/Fax

Practice location:
  • Phone: 203-694-8200
  • Fax:
Mailing address:
  • Phone: 860-483-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4180
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: