Provider Demographics
NPI:1447236542
Name:DEEGAN, PATRICK S (PA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:S
Last Name:DEEGAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 FOUNDERS PLZ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3212
Mailing Address - Country:US
Mailing Address - Phone:860-291-6554
Mailing Address - Fax:860-528-0778
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-289-3375
Practice Address - Fax:860-560-2849
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2018-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT001008363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004211926Medicaid
CTA2516306OtherOXFORD
CT290001008CT03OtherANTHEM BC/BS
CT290001008CT03OtherANTHEM BC/BS
CT970000887Medicare ID - Type Unspecified