Basic Information
| Provider Information | |||||||||
| NPI: | 1699260737 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONNOLLY | ||||||||
| FirstName: | KEVIN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 BERKSHIRE DR | ||||||||
| Address2: | |||||||||
| City: | EAST HAMPTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064241307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608419495 | ||||||||
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| Practice Location | |||||||||
| Address1: | 326 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608898331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2018 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.