Healthcare Provider Details

I. General information

NPI: 1801586813
Provider Name (Legal Business Name): MYAH BARTOLOTTA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 LITCHFIELD ST
TORRINGTON CT
06790-6679
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-496-6666
  • Fax: 860-496-6783
Mailing address:
  • Phone: 860-972-5507
  • Fax: 860-972-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number6174
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: