Provider Demographics
NPI:1457484487
Name:PACHUCKI, DEBRA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANN
Last Name:PACHUCKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4229
Mailing Address - Country:US
Mailing Address - Phone:860-696-2400
Mailing Address - Fax:860-696-2410
Practice Address - Street 1:1025 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4229
Practice Address - Country:US
Practice Address - Phone:860-696-2400
Practice Address - Fax:860-696-2410
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030922207P00000X
CT30922207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400207024Medicare PIN
CTE80538Medicare UPIN