Provider Demographics
NPI:1316556699
Name:BACALIA, RAY ANTHONY APOLONIO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RAY ANTHONY
Middle Name:APOLONIO
Last Name:BACALIA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:13 MUSTER LN
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1735
Mailing Address - Country:US
Mailing Address - Phone:973-495-6001
Mailing Address - Fax:
Practice Address - Street 1:13 MUSTER LN
Practice Address - Street 2:
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339-1735
Practice Address - Country:US
Practice Address - Phone:973-495-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant