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NPI Code Detail

MEDICARE: MRS. JOAN M DOBACK PA-C

MEDICARE: MRS. JOAN M DOBACK 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
1363AS0400XSurgical Physician Assistant000167CT

General Provider Information

NPI Number : 1902888936
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JOAN M DOBACK PA-C
Provider Business Mailing Address
First Line : 57 MARBERN LN
Second Line :
City : NAUGATUCK
State : CT
Zip : 06770-1613
Country : US
Telephone Number : 203-729-9799
Fax Number :
Provider Business Practice Location Address
First Line : 64 ROBBINS ST
Second Line :
City : WATERBURY
State : CT
Zip : 06708-2613
Country : US
Telephone Number : 203-573-7233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 09/24/2008

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Directions to “ MRS. JOAN M DOBACK PA-C” Practice Location

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