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General NPI Number Information
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NPI Number | 1396867958
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Entity Type | Organization
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Legal Business Name | PEDIATRIC CARE ASSOCIATES OF CONNECTICUT
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 25 CONSTITUTION BLVD. SO PEDI-CARE
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City | SHELTON
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State | CT
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Zip | 06484-1300
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Country | US
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Telephone | 203-924-7334
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Fax | 203-922-0004
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Provider Business Mailing Address
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Address Line | 25 CONSTITUTION BLVD S PEDI-CARE
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City | SHELTON
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State | CT
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Zip | 06484-4351
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Country | US
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Telephone | 203-924-7334
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Fax | 203-922-0004
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARIE LECLERC
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Credential |
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Telephone | 203-924-7334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State | CT
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