Healthcare Provider Details

I. General information

NPI: 1891143459
Provider Name (Legal Business Name): HANNAH M S C URGO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH CHALMERS PA

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DAVIS RD E
OLD LYME CT
06371-1413
US

IV. Provider business mailing address

5 DAVIS RD E
OLD LYME CT
06371-1413
US

V. Phone/Fax

Practice location:
  • Phone: 860-390-6000
  • Fax:
Mailing address:
  • Phone: 860-390-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006323
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: