Provider Demographics
NPI:1376793059
Name:HARPER, DOMINIQUE PANTINO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:PANTINO
Last Name:HARPER
Suffix:
Gender:F
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 1:365 MATHER ST
Mailing Address - Street 2:APARTMENT 203
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3148
Mailing Address - Country:US
Mailing Address - Phone:631-805-4548
Mailing Address - Fax:
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002165363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical