Healthcare Provider Details

I. General information

NPI: 1659204592
Provider Name (Legal Business Name): HEIDI POARCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 N MAIN STREET EXT STE 301
WALLINGFORD CT
06492-2434
US

IV. Provider business mailing address

1404 SPINDLE HILL RD
WOLCOTT CT
06716-1228
US

V. Phone/Fax

Practice location:
  • Phone: 203-269-0885
  • Fax: 203-269-3496
Mailing address:
  • Phone: 203-364-7621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7771
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: