Provider Demographics
NPI:1427230804
Name:MASTERSON, DEANN (PA-C)
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:
Last Name:MASTERSON
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 1:71 HAYNES ST
Mailing Address - Street 2:SUITE 1221
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4131
Mailing Address - Country:US
Mailing Address - Phone:860-533-6595
Mailing Address - Fax:960-533-6594
Practice Address - Street 1:171 GRANDVIEW AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2517
Practice Address - Country:US
Practice Address - Phone:203-578-4630
Practice Address - Fax:203-578-4629
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002035363AS0400X
CT2035363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1062414OtherNCCPA