Healthcare Provider Details

I. General information

NPI: 1255366795
Provider Name (Legal Business Name): BRIAN V MCCAMBLEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 MAIN ST
STRATFORD CT
06614-1378
US

IV. Provider business mailing address

6900 MAIN ST
STRATFORD CT
06614-1378
US

V. Phone/Fax

Practice location:
  • Phone: 203-386-6488
  • Fax:
Mailing address:
  • Phone: 203-386-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008705
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000911
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: