MEDICARE: COURTNEY MARQUARDT PA-C

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	4950	CT

General Provider Information

NPI Number	:	1881295913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY MARQUARDT PA-C

Provider Business Mailing Address
First Line	:	25 BUCKLAND RD
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-3703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 BUCKLAND RD
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-3703
Country	:	US
Telephone Number	:	860-698-4301
Fax Number	:

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

Provider Enumeration Date	:	11/04/2020
Last Update Date	:	11/04/2020

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Directions to “ COURTNEY MARQUARDT PA-C” Practice Location

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