Provider Demographics
NPI:1346207057
Name:STRONG, MARIA TERESA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:STRONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:SIRIANNI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2800 MAIN ST
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4201
Mailing Address - Country:US
Mailing Address - Phone:203-576-5604
Mailing Address - Fax:203-576-6368
Practice Address - Street 1:2800 MAIN ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4201
Practice Address - Country:US
Practice Address - Phone:203-576-5604
Practice Address - Fax:203-576-6368
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant