MEDICARE: DENISE E COLOGNE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	000906	CT
2	363AM0700X	Medical Physician Assistant	000906	CT
3	363AS0400X	Surgical Physician Assistant	000906	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1083681910	OTHER	CT	NPI

General Provider Information

NPI Number	:	1083681910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE E COLOGNE PA

Provider Business Mailing Address
First Line	:	PO BOX 415933
Second Line	:	HARTFORD HOSPITAL PROFESSIONAL SERVICES
City	:	BOSTON
State	:	MA
Zip	:	02241-5933
Country	:	US
Telephone Number	:	860-972-9047
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 RETREAT AVE
Second Line	:	HARTFORD HOSPITAL MEDICINE DEPT IOL DONNELLY BUIDLING,
City	:	HARTFORD
State	:	CT
Zip	:	06106-3309
Country	:	US
Telephone Number	:	860-545-7224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	05/22/2014

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Directions to “ DENISE E COLOGNE PA” Practice Location

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