Provider Demographics
NPI:1467565457
Name:AMICO, CAROL A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:AMICO
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1450 CHAPEL ST
Mailing Address - Street 2:YALE-NEW HAVEN HOSPITAL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4405
Mailing Address - Country:US
Mailing Address - Phone:203-789-4135
Mailing Address - Fax:203-867-5241
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:YALE-NEW HAVEN HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-4135
Practice Address - Fax:203-867-5241
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2015-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT000077363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ74194Medicare UPIN
CT970002277Medicare PIN