1851631683 NPI number — TIA JEAN WILLIAMS PA-C, MMSC

Table of content: TIA JEAN WILLIAMS PA-C, MMSC (NPI 1851631683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851631683 NPI number — TIA JEAN WILLIAMS PA-C, MMSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
TIA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C, MMSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERRAROTTI
Provider Other First Name:
TIA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C, MMSC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851631683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
538 LITCHFIELD ST STE G01
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06790-6669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-496-9877
Provider Business Mailing Address Fax Number:
860-496-0441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 CROMWELL AVE # 404
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY HILL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-525-4469
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 002877 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)