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General NPI Number Information
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NPI Number | 1093024978
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Entity Type | Individual
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Provider Name | LISA ANN MCCARROLL PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 28 CRESCENT ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3654
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Country | US
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Telephone | 860-358-6572
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Fax |
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Provider Business Mailing Address
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Address Line | 52 HOMESDALE AVE
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City | SOUTHINGTON
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State | CT
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Zip | 06489-3742
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Country | US
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Telephone | 860-621-1576
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 002457
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 002457
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License Number State | CT
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