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General NPI Number Information
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NPI Number | 1336601616
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Entity Type | Individual
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Provider Name | BRANDON RAYMOND RAGOZZINO PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/04/2019
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 1 BUCKLAND RD STE 7
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3764
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Country | US
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Telephone | 860-698-4301
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 AVON BLVD
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City | CHESHIRE
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State | CT
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Zip | 06410-3608
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Country | US
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Telephone | 203-927-3702
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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 | 4372
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License Number State | CT
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