Provider Demographics
NPI:1275609984
Name:MACKEY, JOHN NEWTON (PHYSICIANS ASSITANT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NEWTON
Last Name:MACKEY
Suffix:
Gender:M
Credentials:PHYSICIANS ASSITANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 NORWICH ROAD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374
Mailing Address - Country:US
Mailing Address - Phone:860-564-4054
Mailing Address - Fax:860-564-0354
Practice Address - Street 1:558 NORWICH ROAD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374
Practice Address - Country:US
Practice Address - Phone:860-564-4054
Practice Address - Fax:860-564-0354
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001429363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004224490Medicaid
CT290001429CT02OtherBC BS