Provider Demographics
NPI:1275008153
Name:REMES, BRIAN W (PA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:REMES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3088
Mailing Address - Country:US
Mailing Address - Phone:860-243-8709
Mailing Address - Fax:860-243-8259
Practice Address - Street 1:580 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3088
Practice Address - Country:US
Practice Address - Phone:860-243-8709
Practice Address - Fax:860-243-8259
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4273OtherCT STATE PHYSICIAN ASSISTAN LICENSE