Provider Demographics
NPI:1114329125
Name:GUERIN, MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GUERIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 STRAITS TURNPIKE, SUITE E
Mailing Address - Street 2:ORTHOPAEDICS NEW ENGLAND PC
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762
Mailing Address - Country:US
Mailing Address - Phone:203-598-0700
Mailing Address - Fax:877-345-6922
Practice Address - Street 1:1579 STRAITS TURNPIKE, SUITE E
Practice Address - Street 2:ORTHOPAEDICS NEW ENGLAND PC
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762
Practice Address - Country:US
Practice Address - Phone:203-598-0700
Practice Address - Fax:877-345-6922
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3187363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01925Medicare PIN
CTD400171925Medicare PIN